Provider Demographics
NPI:1487041299
Name:CAMPBELL, NATASHA
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01061-0912
Mailing Address - Country:US
Mailing Address - Phone:413-341-0085
Mailing Address - Fax:413-895-5532
Practice Address - Street 1:26 S PROSPECT ST STE 204
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2252
Practice Address - Country:US
Practice Address - Phone:413-341-0085
Practice Address - Fax:413-895-5532
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6701486Medicaid
MA110153006AMedicaid