Provider Demographics
NPI:1497862106
Name:CAMPBELL, MARGERY WILLCOX (LCSW R)
Entity Type:Individual
Prefix:MS
First Name:MARGERY
Middle Name:WILLCOX
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 ROUTE 12 B
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-0000
Mailing Address - Country:US
Mailing Address - Phone:315-691-9719
Mailing Address - Fax:315-691-9719
Practice Address - Street 1:478 ROUTE 12 B
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-0000
Practice Address - Country:US
Practice Address - Phone:315-691-9719
Practice Address - Fax:315-691-9719
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0502821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P42641Medicare UPIN
NYCC9417Medicare ID - Type Unspecified