Provider Demographics
NPI:1184232738
Name:CAMPBELL, LAUREN (ATR-LCAT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ATR-LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 VALLEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1326
Mailing Address - Country:US
Mailing Address - Phone:631-748-7937
Mailing Address - Fax:
Practice Address - Street 1:13 VALLEYWOOD DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1326
Practice Address - Country:US
Practice Address - Phone:631-748-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001216-01221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist