Provider Demographics
NPI:1427429794
Name:CAMPBELL
Entity type:Organization
Organization Name:CAMPBELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAIAH
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:215-206-9502
Mailing Address - Street 1:125 LANSDOWNE COURT
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050
Mailing Address - Country:US
Mailing Address - Phone:610-394-8668
Mailing Address - Fax:610-394-6929
Practice Address - Street 1:600 ABBOTT DR
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-4317
Practice Address - Country:US
Practice Address - Phone:610-394-8668
Practice Address - Fax:610-394-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health