Provider Demographics
NPI:1912007014
Name:CAMPBELL, NICOLE LESLIE (MSW, DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LESLIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSW, DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-4506
Mailing Address - Country:US
Mailing Address - Phone:323-205-7088
Mailing Address - Fax:833-419-0181
Practice Address - Street 1:100 PEARL ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-4506
Practice Address - Country:US
Practice Address - Phone:323-205-7088
Practice Address - Fax:833-419-0181
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT64691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical