Basic Information
| Provider Information | |||||||||
| NPI: | 1366698565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPOS | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | GLENN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7621 CANOGA AVE | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913044912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185986900 | ||||||||
| FaxNumber: | 8185986971 | ||||||||
| Practice Location | |||||||||
| Address1: | 7621 CANOGA AVE | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913044912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185986900 | ||||||||
| FaxNumber: | 8185986971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2008 | ||||||||
| LastUpdateDate: | 05/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS18147 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.