Healthcare Provider Details

I. General information

NPI: 1487778775
Provider Name (Legal Business Name): ELISABETH CAMPBELL ARCHIE MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MURRAY STREET FAMILY SERVICES OF GREATER WATERBURY
WATERBURY CT
06710-1920
US

IV. Provider business mailing address

34 MURRAY STREET
WATERBURY CT
06710-1920
US

V. Phone/Fax

Practice location:
  • Phone: 203-756-8317
  • Fax: 203-756-8310
Mailing address:
  • Phone: 203-756-8317
  • Fax: 203-756-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005548
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: