Healthcare Provider Details

I. General information

NPI: 1114880754
Provider Name (Legal Business Name): OLIVIA CAMPOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BIRCH ST STE 204
MILFORD MA
01757-3585
US

IV. Provider business mailing address

54 GRANDVIEW AVE
WOONSOCKET RI
02895-2607
US

V. Phone/Fax

Practice location:
  • Phone: 401-659-5081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: