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General NPI Number Information
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NPI Number | 1235489881
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Entity Type | Organization
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Legal Business Name | MONICA CAMPBELL, PH.D., LLC
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 1500 WALNUT ST SUITE 902
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City | PHILADELPHIA
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State | PA
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Zip | 19102-3523
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Country | US
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Telephone | 215-964-8335
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34210
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City | PHILADELPHIA
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State | PA
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Zip | 19101-4210
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Country | US
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Telephone | 215-964-8335
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. MONICA THOMPSON CAMPBELL
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Credential | PH.D.
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Telephone | 215-964-8335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS015555
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License Number State | PA
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