1801066782 NPI number — MR. FERRANDO CAMPBELL LMHC

Table of content: MR. FERRANDO CAMPBELL LMHC (NPI 1801066782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801066782 NPI number — MR. FERRANDO CAMPBELL LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
FERRANDO
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801066782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
995 BLUE HILL AVENUE
Provider Second Line Business Mailing Address:
ABAC, INC.
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-822-0829
Provider Business Mailing Address Fax Number:
671-825-7804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
995 BLUE HILL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORCHESTER CENTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02124-2828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-822-0829
Provider Business Practice Location Address Fax Number:
617-825-7804
Provider Enumeration Date:
03/06/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  7591 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1303414 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".