Healthcare Provider Details

I. General information

NPI: 1629993308
Provider Name (Legal Business Name): THERESA CAMPANALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16-24 UNION ST.
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

16-24 UNION ST.
MIDDLETOWN NY
10940
US

V. Phone/Fax

Practice location:
  • Phone: 845-801-5682
  • Fax:
Mailing address:
  • Phone: 845-633-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: