MEDICARE: MS. JEAN CHRISTINE CAMPBELL LICSW

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	12732	MD
2	1041C0700X	Clinical Social Worker	LC50077887	DC

General Provider Information

NPI Number	:	1598819559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEAN CHRISTINE CAMPBELL LICSW

Provider Business Mailing Address
First Line	:	PO BOX 107
Second Line	:
City	:	GARRETT PARK
State	:	MD
Zip	:	20896-0107
Country	:	US
Telephone Number	:	202-271-1301
Fax Number	:

Provider Business Practice Location Address
First Line	:	5028 WISCONSIN AVE NW STE 400
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-4118
Country	:	US
Telephone Number	:	202-271-1301
Fax Number	:

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/24/2019

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Directions to “ MS. JEAN CHRISTINE CAMPBELL LICSW” Practice Location

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