Provider Demographics
NPI:1578709689
Name:CAMPBELL, EVELYN M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:595 BETHLEHEM PIKE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-9710
Mailing Address - Country:US
Mailing Address - Phone:215-997-7772
Mailing Address - Fax:215-434-7285
Practice Address - Street 1:595 BETHLEHEM PIKE
Practice Address - Street 2:SUITE222
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9710
Practice Address - Country:US
Practice Address - Phone:215-997-7772
Practice Address - Fax:215-434-7285
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health