Provider Demographics
NPI:1982913695
Name:CAMPOS, JANNETT (LCSW)
Entity type:Individual
Prefix:
First Name:JANNETT
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 GLEN ST UNIT 4E
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3067
Mailing Address - Country:US
Mailing Address - Phone:860-438-9691
Mailing Address - Fax:
Practice Address - Street 1:664 PROSPECT AVE SIDE 1
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4255
Practice Address - Country:US
Practice Address - Phone:860-438-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT112101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical