Healthcare Provider Details

I. General information

NPI: 1598727729
Provider Name (Legal Business Name): SUSAN O.K. CAMPAGNOLA L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 MAIN ST
WARSAW VA
22572-4291
US

IV. Provider business mailing address

9228 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER VA
23061-4162
US

V. Phone/Fax

Practice location:
  • Phone: 804-333-3671
  • Fax: 804-333-3657
Mailing address:
  • Phone: 804-693-5068
  • Fax: 804-693-7407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0904004978
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: