Provider Demographics
NPI:1649448697
Name:CAMPBELL, KORIN (LCSW)
Entity type:Individual
Prefix:
First Name:KORIN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KORIN
Other - Middle Name:
Other - Last Name:JACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 MAPLE AVENUE
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1722
Mailing Address - Country:US
Mailing Address - Phone:860-386-8024
Mailing Address - Fax:
Practice Address - Street 1:61 BLOOMFIELD AVE
Practice Address - Street 2:FL 1
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2809
Practice Address - Country:US
Practice Address - Phone:860-386-8024
Practice Address - Fax:860-909-0032
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0076551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical