Provider Demographics
NPI:1477906683
Name:CAMPBELL DECOCK, LUCILE M (LADC LICSW)
Entity Type:Individual
Prefix:
First Name:LUCILE
Middle Name:M
Last Name:CAMPBELL DECOCK
Suffix:
Gender:F
Credentials:LADC LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4226
Mailing Address - Country:US
Mailing Address - Phone:518-886-5601
Mailing Address - Fax:518-886-5805
Practice Address - Street 1:24 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-886-5601
Practice Address - Fax:518-886-5805
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0874441041C0700X
VT089.01220991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical