Provider Demographics
NPI:1730353947
Name:CAMPAGNOLA, DAWN MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:CAMPAGNOLA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-0141
Mailing Address - Country:US
Mailing Address - Phone:650-704-9586
Mailing Address - Fax:
Practice Address - Street 1:200 MAPLE AVE STE 100
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1732
Practice Address - Country:US
Practice Address - Phone:650-704-9586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist