Provider Demographics
NPI:1902544588
Name:CAMPBELL, CASHEL S (LCAT)
Entity Type:Individual
Prefix:
First Name:CASHEL
Middle Name:S
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 W 29TH ST APT 7K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1395
Mailing Address - Country:US
Mailing Address - Phone:718-971-4409
Mailing Address - Fax:
Practice Address - Street 1:529 W 29TH ST APT 7K
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1395
Practice Address - Country:US
Practice Address - Phone:718-971-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002652-01225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist