Healthcare Provider Details

I. General information

NPI: 1013226810
Provider Name (Legal Business Name): PAMELA A CAMPBELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195-199 W. DOMMICK ST.
ROME NY
13440-5855
US

IV. Provider business mailing address

293 GENESEE ST
UTICA NY
13501-3804
US

V. Phone/Fax

Practice location:
  • Phone: 315-272-2730
  • Fax: 315-337-0675
Mailing address:
  • Phone: 315-272-2600
  • Fax: 315-733-8169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number075450
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number079403
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: