Provider Demographics
NPI:1902949886
Name:CAMPANO WOOD, GEORGETTE CAMPANO (LPC MENTAL HEALTH CO)
Entity Type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:CAMPANO
Last Name:CAMPANO WOOD
Suffix:
Gender:F
Credentials:LPC MENTAL HEALTH CO
Other - Prefix:
Other - First Name:GEORGETTE
Other - Middle Name:CAMPANO
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 WEST MAIN ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4032
Mailing Address - Country:US
Mailing Address - Phone:203-480-3757
Mailing Address - Fax:203-481-9536
Practice Address - Street 1:250 WEST MAIN ST
Practice Address - Street 2:SUITE 14
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-4032
Practice Address - Country:US
Practice Address - Phone:203-480-3757
Practice Address - Fax:203-481-9536
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001237101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional