MEDICARE: LUCILLE CAMPBELL LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	S.1701187	OH
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN536984	OH

General Provider Information

NPI Number	:	1366924128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCILLE CAMPBELL LSW

Provider Business Mailing Address
First Line	:	2500 DERBYSHIRE RD APT 12
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3231
Country	:	US
Telephone Number	:	216-990-1979
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 DERBYSHIRE RD APT 12
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3231
Country	:	US
Telephone Number	:	216-990-1979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	12/12/2025

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Directions to “ LUCILLE CAMPBELL LSW” Practice Location

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