Provider Demographics
NPI:1447442371
Name:LEJEUNE KAMPAN, GWENDOLYNE RAYMONNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYNE
Middle Name:RAYMONNE
Last Name:LEJEUNE KAMPAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-2957
Mailing Address - Country:US
Mailing Address - Phone:818-256-2206
Mailing Address - Fax:
Practice Address - Street 1:919 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-2957
Practice Address - Country:US
Practice Address - Phone:818-256-2206
Practice Address - Fax:818-256-2206
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALCS283821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health