Provider Demographics
NPI:1750586434
Name:CAMPBELL, GINA M (MSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 SPENCER RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5328
Mailing Address - Country:US
Mailing Address - Phone:607-277-5300
Mailing Address - Fax:
Practice Address - Street 1:207 E COURT ST
Practice Address - Street 2:NUMBER 5
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4279
Practice Address - Country:US
Practice Address - Phone:607-592-9620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health