Provider Demographics
NPI:1679261408
Name:CAMPBELL, ELLIOTT ANDREW (LSW)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:ANDREW
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 LYSLE AVE
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15133-3901
Mailing Address - Country:US
Mailing Address - Phone:412-401-8192
Mailing Address - Fax:
Practice Address - Street 1:5301 BUTLER ST STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201-2658
Practice Address - Country:US
Practice Address - Phone:412-441-9786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PASW139854104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health