=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861935900
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA ISABEL CAMPO LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2016
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 CENTRAL AVE
-----------------------------------------------------
City | NORTH HALEDON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07508-2560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-264-9594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 180 CENTRAL AVE
-----------------------------------------------------
City | NORTH HALEDON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07508-2560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-264-9594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 944360
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 37PC01031100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------