Provider Demographics
NPI:1891894960
Name:CAMPBELL, NANCY C (LICSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:CAMPBELL
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 1:114 BIANCA RD
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-3508
Mailing Address - Country:US
Mailing Address - Phone:781-585-2454
Mailing Address - Fax:
Practice Address - Street 1:113 TREMONT ST
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4753
Practice Address - Country:US
Practice Address - Phone:781-934-6226
Practice Address - Fax:781-934-7037
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1137181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical