Provider Demographics
NPI:1558638395
Name:CAMBELL, ANA ISSELA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ANA
Middle Name:ISSELA
Last Name:CAMBELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR STE 325J
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6119
Mailing Address - Country:US
Mailing Address - Phone:508-843-9982
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 325J
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6119
Practice Address - Country:US
Practice Address - Phone:508-843-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1201621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical