Provider Demographics
NPI:1427192467
Name:CAMPAGNA, ALAN R (PSYD MSW)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:CAMPAGNA
Suffix:
Gender:M
Credentials:PSYD MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 NEW CREST ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-3138
Mailing Address - Country:US
Mailing Address - Phone:413-313-3591
Mailing Address - Fax:413-610-0060
Practice Address - Street 1:733 CHAPIN ST
Practice Address - Street 2:SUIT 200D
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-1900
Practice Address - Country:US
Practice Address - Phone:413-313-3591
Practice Address - Fax:413-610-0060
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2029523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health