Healthcare Provider Details

I. General information

NPI: 1982913695
Provider Name (Legal Business Name): JANNETT CAMPOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 PROSPECT AVE SIDE 1
HARTFORD CT
06105-4255
US

IV. Provider business mailing address

239 GLEN ST UNIT 4E
NEW BRITAIN CT
06051-3067
US

V. Phone/Fax

Practice location:
  • Phone: 860-438-9691
  • Fax:
Mailing address:
  • Phone: 860-438-9691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11210
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: