Provider Demographics
NPI:1982498572
Name:CAMPOS PACHECO, JOHANNA P
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:P
Last Name:CAMPOS PACHECO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7948 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2917
Mailing Address - Country:US
Mailing Address - Phone:718-710-1635
Mailing Address - Fax:718-710-1635
Practice Address - Street 1:639 BOND CT
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1240
Practice Address - Country:US
Practice Address - Phone:718-710-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker