Provider Demographics
NPI:1487982914
Name:CAMPBELL, CHRISTINE ROSEMARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ROSEMARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:ROSEMARIE
Other - Last Name:DOWNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1499 ISLIP AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3902
Mailing Address - Country:US
Mailing Address - Phone:917-686-3344
Mailing Address - Fax:
Practice Address - Street 1:1499 ISLIP AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722
Practice Address - Country:US
Practice Address - Phone:917-686-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional