Provider Demographics
NPI:1679679302
Name:CAMPBELL, ROBERT PATRICK (LISW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PATRICK
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 DELAWARE AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5073
Mailing Address - Country:US
Mailing Address - Phone:740-223-1322
Mailing Address - Fax:740-223-1332
Practice Address - Street 1:685 DELAWARE AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5073
Practice Address - Country:US
Practice Address - Phone:740-223-1322
Practice Address - Fax:740-223-1332
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0005129104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH800885309-00OtherBUREAU OF WORKERS' COMPENSATION