Provider Demographics
NPI:1487093928
Name:CAMPO, SAL ANTHONY (LICSW)
Entity type:Individual
Prefix:MR
First Name:SAL
Middle Name:ANTHONY
Last Name:CAMPO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 LOXFORD TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1125
Mailing Address - Country:US
Mailing Address - Phone:301-526-8587
Mailing Address - Fax:
Practice Address - Street 1:1628 11TH ST NW
Practice Address - Street 2:SUITE LL 112
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-5011
Practice Address - Country:US
Practice Address - Phone:202-232-4270
Practice Address - Fax:202-232-4394
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500777471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical