Provider Demographics
NPI:1033260971
Name:CAMPBELL, DONNA RAYE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:RAYE
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 1:6 HILL VIEW LANE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798
Mailing Address - Country:US
Mailing Address - Phone:203-218-5303
Mailing Address - Fax:
Practice Address - Street 1:8 WEST STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-792-3272
Practice Address - Fax:203-792-3272
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0008401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008030409Medicaid