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General NPI Number Information
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NPI Number | 1912537010
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Entity Type | Individual
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Provider Name | JILLIAN L. CAMPBELL
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Gender | Female
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Dates
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Enumeration Date | 01/17/2020
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 340 DOGWOOD AVE STE 106
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-3400
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Country | US
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Telephone | 516-505-1717
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Fax | 516-505-1627
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Provider Business Mailing Address
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Address Line | 340 DOGWOOD AVE STE 106
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-3400
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Country | US
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Telephone | 516-505-1717
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Fax | 516-505-1627
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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 | 011774
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License Number State | NY
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