Provider Demographics
NPI:1396499059
Name:CAMPOREALE, PAMELA
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:CAMPOREALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 EAST ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5018
Mailing Address - Country:US
Mailing Address - Phone:203-495-7710
Mailing Address - Fax:
Practice Address - Street 1:426 EAST ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5018
Practice Address - Country:US
Practice Address - Phone:203-495-7710
Practice Address - Fax:203-495-7713
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001237101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)