Basic Information
| Provider Information | |||||||||
| NPI: | 1689217481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 WATERFORD CIR | ||||||||
| Address2: | |||||||||
| City: | DIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027151167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088377658 | ||||||||
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| Practice Location | |||||||||
| Address1: | 126 COVE ST | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027201357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086780041 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2019 | ||||||||
| LastUpdateDate: | 10/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 000225407 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.