Basic Information
| Provider Information | |||||||||
| NPI: | 1407180383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | TRACY-ANN | ||||||||
| MiddleName: | CAMILLE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11031 NE 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331617182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053986100 | ||||||||
| FaxNumber: | 3057574465 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 NW 59TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331271218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057583634 | ||||||||
| FaxNumber: | 3057595869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2009 | ||||||||
| LastUpdateDate: | 09/25/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.