1194950154 NPI number — MRS. MARY LAVINIA CAMPBELL LCSWR, CDE

Table of content: MRS. MARY LAVINIA CAMPBELL LCSWR, CDE (NPI 1194950154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194950154 NPI number — MRS. MARY LAVINIA CAMPBELL LCSWR, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
MARY
Provider Middle Name:
LAVINIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMPBELL
Provider Other First Name:
LIN
Provider Other Middle Name:
X
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSWR, CDE
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1194950154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 E 11TH ST
Provider Second Line Business Mailing Address:
438
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10003-6811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-533-3884
Provider Business Mailing Address Fax Number:
718-855-3004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 E 11TH ST
Provider Second Line Business Practice Location Address:
438
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-6811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-533-3884
Provider Business Practice Location Address Fax Number:
718-855-3004
Provider Enumeration Date:
05/20/2009

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: 103K00000X , with the licence number:  R-0376750 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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