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NPI Code Detail

MEDICARE: SUSAN O.K. CAMPAGNOLA L.C.S.W.

MEDICARE: SUSAN O.K. CAMPAGNOLA L.C.S.W.
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
1104100000XSocial Worker0904004978VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1114431OTHERVAHEALTHKEEPERS
2114431OTHERVAANTHEM
3331724OTHERVATRICARE
47093521OTHERVAAETNA
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7O80431MOTHERVASOUTHERN HEALTH

General Provider Information

NPI Number : 1598727729
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN O.K. CAMPAGNOLA L.C.S.W.
Provider Business Mailing Address
First Line : 9228 GEORGE WASHINGTON MEMORIAL HWY
Second Line :
City : GLOUCESTER
State : VA
Zip : 23061-4162
Country : US
Telephone Number : 804-693-5068
Fax Number : 804-693-7407
Provider Business Practice Location Address
First Line : 414 MAIN ST
Second Line :
City : WARSAW
State : VA
Zip : 22572-4291
Country : US
Telephone Number : 804-333-3671
Fax Number : 804-333-3657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2006
Last Update Date : 09/27/2007

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