Shushan Campbell, PH.D., LCP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810006451 Issued in VA

Practice address

10521 Rosehaven St Ste 100
Fairfax, VA 22030-2877

Phone

(703) 352-3822

NPI assigned

Jul 16, 2014

Reactivated

Apr 8, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Campbell Integrative Psychological Services

  • Clinical Psychologist
  • MC Lean, VA
  • NPI 1750020954
  NPD Authorized official
• Lape Psychology Services PLLC

  • Clinical Psychologist
  • New York, NY
  • NPI 1730815564
  NPD Authorized official
• Child & Family Counseling Group

  • Psychiatry Physician
  • Fairfax, VA
  • NPI 1306024914

  Clinical

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586304000000",
    "number": "1265849822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10521 ROSEHAVEN ST",
            "address_2": "SUITE 100",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302876",
            "telephone_number": "703-352-3822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10521 ROSEHAVEN ST STE 100",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302877",
            "telephone_number": "703-352-3822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "SHUSHAN",
        "name_prefix": "Dr.",
        "credential": "PH.D., LCP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-16",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "deactivation_date": "2019-03-27",
        "reactivation_date": "2020-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810006451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOLE PROPRIETOR",
            "identifier": "1265849822",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.childandfamilycounseling.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10521 Rosehaven St Ste 100",
            "city": "Fairfax",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220302877",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Daniel F. Campbell, LCSW
• Erica Nicole Campbell, M.D.
• Gail W Campbell, LPC, LSATP
• Joshua Clark Campbell, MD
• Marketa Campbell
• Caroline Buths Campesi, DPT
• Eric J Campesi, DPT
• Leigh Campo
• Lisa Ann Campo, NP
• Tatiana Y Campos

• Clinical Psychologist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.