1699764076 NPI number — JUNE CAMPBELL-VANREMMEN LCSW

Table of content: JUNE CAMPBELL-VANREMMEN LCSW (NPI 1699764076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699764076 NPI number — JUNE CAMPBELL-VANREMMEN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL-VANREMMEN
Provider First Name:
JUNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699764076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4184 SENECA ST
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
WEST SENECA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14224-3051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-675-4962
Provider Business Mailing Address Fax Number:
716-675-4978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4184 SENECA ST
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
WEST SENECA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14224-3051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-675-4962
Provider Business Practice Location Address Fax Number:
716-675-4978
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  R045342-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: R045342-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00020374802 . This is a "UNIVERA HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000525457004 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6210970 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 137910 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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