Provider Demographics
NPI:1497393441
Name:CAMPANA, JULIE ELAINE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ELAINE
Last Name:CAMPANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SILVERSIDE RD STE 50
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1388
Mailing Address - Country:US
Mailing Address - Phone:302-791-9502
Mailing Address - Fax:
Practice Address - Street 1:501 SILVERSIDE RD STE 50
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-1388
Practice Address - Country:US
Practice Address - Phone:302-791-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC000096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health