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General NPI Number Information
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NPI Number | 1780420216
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Entity Type | Individual
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Provider Name | SANDRA CAMPOHERMOSO LMHC
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Gender | Female
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Dates
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Enumeration Date | 07/03/2024
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 3600 ROUTE 112
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City | CORAM
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State | NY
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Zip | 11727-4116
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Country | US
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Telephone | 631-920-8500
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Fax | 631-920-8477
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Provider Business Mailing Address
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Address Line | 3141 UNION BLVD
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City | EAST ISLIP
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State | NY
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Zip | 11730-1904
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Country | US
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Telephone | 631-745-8347
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NY
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