Neural cell adhesion molecule (NCAM) was originally characterised as a homophilic cell adhesion molecule (CAM) abundantly expressed in the nervous system. However, the last decade of research has challenged the traditional view and defined novel roles for NCAM. NCAM is now considered a signaling receptor that responds to both homophilic and heterophilic cues, as well as a mediator of cell-cell adhesion. This review describes NCAM function at the molecular level. We discuss recent models for extracellular ligand-interactions of NCAM, and the intracellular signaling cascade that follows to define cellular outcomes such as neurite outgrowth.