Provider Demographics
NPI:1598988354
Name:CAMPBELL, PATRICIA LORRAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LORRAINE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2518
Mailing Address - Country:US
Mailing Address - Phone:626-533-3031
Mailing Address - Fax:
Practice Address - Street 1:2366 MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2518
Practice Address - Country:US
Practice Address - Phone:626-533-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS138731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical