Provider Demographics
NPI:1124072210
Name:CAMPBELL AND SANTORO PSYCHOLOGISTS, PC
Entity type:Organization
Organization Name:CAMPBELL AND SANTORO PSYCHOLOGISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:631-979-0438
Mailing Address - Street 1:111 SMITHTOWN BYP
Mailing Address - Street 2:SUITE 121
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2524
Mailing Address - Country:US
Mailing Address - Phone:631-979-0438
Mailing Address - Fax:631-979-0438
Practice Address - Street 1:19544 WOODHULL AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2982
Practice Address - Country:US
Practice Address - Phone:718-740-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013294103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05259Medicare ID - Type Unspecified