Provider Demographics
NPI:1255531067
Name:CAMPBELL, MICHAEL HARRY (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HARRY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 EDWARDS DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2042
Mailing Address - Country:US
Mailing Address - Phone:941-870-4913
Mailing Address - Fax:
Practice Address - Street 1:SCHOOL OF CLINICAL MEDICINE AND RESEARCH
Practice Address - Street 2:U. OF THE WEST INDIES, QUEEN ELIZABETH HOSPITAL
Practice Address - City:BRIDGETOWN
Practice Address - State:ST. MICHAEL
Practice Address - Zip Code:BB
Practice Address - Country:BB
Practice Address - Phone:246-429-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5987103T00000X, 103TC1900X
FLPY5987103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service