Provider Demographics
NPI:1447442793
Name:CAMPBELL, NANCY C (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:C
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:C
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:7 BENTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1321 WASHINTON AVENUE
Practice Address - Street 2:308
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103
Practice Address - Country:US
Practice Address - Phone:207-797-4555
Practice Address - Fax:207-797-4558
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC60671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432631099Medicaid