Provider Demographics
NPI:1215144803
Name:CAMPBELL, BERNADETTE (LCSW)
Entity type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BAYCHESTER AVE
Mailing Address - Street 2:SUITE 9G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1704
Mailing Address - Country:US
Mailing Address - Phone:718-671-2009
Mailing Address - Fax:718-671-2009
Practice Address - Street 1:900 BAYCHESTER AVE
Practice Address - Street 2:SUITE 9G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1704
Practice Address - Country:US
Practice Address - Phone:718-671-2009
Practice Address - Fax:718-671-2009
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0322531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical