Provider Demographics
NPI:1023183696
Name:CAMPBELL, CATHERINE PEARCE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:PEARCE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 WEST ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1234
Mailing Address - Country:US
Mailing Address - Phone:508-422-0248
Mailing Address - Fax:508-422-0261
Practice Address - Street 1:288 WEST ST STE 3B
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1234
Practice Address - Country:US
Practice Address - Phone:508-422-0248
Practice Address - Fax:508-422-0261
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10219761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06933Medicare ID - Type UnspecifiedMEDICARE