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General NPI Number Information
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NPI Number | 1124199930
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Entity Type | Individual
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Provider Name | ELIZABETH LYNN CAMPBELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 9729 64TH RD
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City | REGO PARK
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State | NY
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Zip | 11374-2240
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Country | US
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Telephone | 718-896-3400
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Fax | 718-459-5621
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Provider Business Mailing Address
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Address Line | 3441 85TH ST 4C
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-3246
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Country | US
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Telephone | 718-478-2430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 069421
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License Number State | NY
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