Healthcare Provider Details

I. General information

NPI: 1982720421
Provider Name (Legal Business Name): MONIKA ANN BANG-CAMPBELL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TER HEUN DR
FALMOUTH MA
02540-2525
US

IV. Provider business mailing address

43 DRUMLIN RD
FALMOUTH MA
02540-2505
US

V. Phone/Fax

Practice location:
  • Phone: 508-540-6550
  • Fax: 508-540-7480
Mailing address:
  • Phone: 508-540-5174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113968
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: