Basic Information
Provider Information
NPI: 1003141375
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAMPBELL
FirstName: JAMIE
MiddleName: LEE
NamePrefix:  
NameSuffix:  
Credential: LSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MAIOLA
OtherFirstName: JAMIE
OtherMiddleName: LEE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 5
Mailing Information
Address1: 1011 BINGHAM ST
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152031101
CountryCode: US
TelephoneNumber: 4122980987
FaxNumber: 4122355387
Practice Location
Address1: 1011 BINGHAM ST
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152031101
CountryCode: US
TelephoneNumber: 4122980987
FaxNumber: 4122355387
Other Information
ProviderEnumerationDate: 10/05/2009
LastUpdateDate: 10/05/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XSW123538 Y Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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