Basic Information
| Provider Information | |||||||||
| NPI: | 1073653812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAREWELL CAMPBELL | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 WATERVILLE ST | ||||||||
| Address2: | |||||||||
| City: | NORTH GRAFTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015361823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088396682 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 29 PINE ST | ||||||||
| Address2: | GB WELLS CENTER | ||||||||
| City: | SOUTHBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015501823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087659167 | ||||||||
| FaxNumber: | 5087642462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 5737 | MA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.