MEDICARE: JANET L. CAMPBELL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R034596	NY

General Provider Information

NPI Number	:	1538133970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET L. CAMPBELL LCSW

Provider Business Mailing Address
First Line	:	22 NORTH RD., PO BOX 166
Second Line	:
City	:	BLOOMINGBURG
State	:	NY
Zip	:	12721
Country	:	US
Telephone Number	:	845-733-6759
Fax Number	:	845-733-6759

Provider Business Practice Location Address
First Line	:	22 NORTH ST
Second Line	:
City	:	BLOOMINGBURG
State	:	NY
Zip	:	12721-4654
Country	:	US
Telephone Number	:	845-733-6759
Fax Number	:	845-733-6759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	04/22/2008

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