Provider Demographics
NPI:1013226810
Name:CAMPBELL, PAMELA A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:CAMPBELL
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 1:293 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-3804
Mailing Address - Country:US
Mailing Address - Phone:315-272-2600
Mailing Address - Fax:315-733-8169
Practice Address - Street 1:195-199 W. DOMMICK ST.
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5855
Practice Address - Country:US
Practice Address - Phone:315-272-2730
Practice Address - Fax:315-337-0675
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0754501041S0200X
NY0794031041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool