MEDICARE: MR. JOHN ROBERT CAMPANA SR. LCSW, CAP, CEAP

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	SW7298	FL

General Provider Information

NPI Number	:	1669526828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ROBERT CAMPANA SR. LCSW, CAP, CEAP

Provider Business Mailing Address
First Line	:	1408 N WEST SHORE BLVD
Second Line	:	SUITE 502
City	:	TAMPA
State	:	FL
Zip	:	33607-4525
Country	:	US
Telephone Number	:	813-281-8955
Fax Number	:	813-281-2474

Provider Business Practice Location Address
First Line	:	1408 N WEST SHORE BLVD
Second Line	:	SUITE 502
City	:	TAMPA
State	:	FL
Zip	:	33607-4525
Country	:	US
Telephone Number	:	813-281-8955
Fax Number	:	813-281-2474

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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