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General NPI Number Information
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NPI Number | 1255881660
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Entity Type | Individual
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Provider Name | STEPHANIE CAMPOS LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 18 SUMMER AVE
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City | GREAT NECK
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State | NY
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Zip | 11020-1524
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Country | US
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Telephone | 516-581-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 203 W 111TH ST APT 4B
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City | NEW YORK
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State | NY
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Zip | 10026-4159
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Country | US
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Telephone | 151-658-1789
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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 | 44SL06555500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 094613-1
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License Number State | NY
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