Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | RO42678-1 | NY |
NPI | 1003036658 |
---|---|
Provider Name | Ingrid Sharon Campbell |
First Address | Northport, NY 11768-9797 |
Second Address | Northport, NY 11768-2932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 04/02/2010 |