Healthcare Provider Details

I. General information

NPI: 1033351978
Provider Name (Legal Business Name): DAVID MICHAEL CAMPANARO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 STRINGHAM RD APT 5
LAGRANGEVILLE NY
12540-5542
US

IV. Provider business mailing address

PO BOX 76
LAGRANGEVILLE NY
12540-0076
US

V. Phone/Fax

Practice location:
  • Phone: 845-702-2400
  • Fax:
Mailing address:
  • Phone: 845-702-2400
  • Fax: 845-291-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number080675
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: