1255467585 NPI number — MS. ELISABETH HEDWIG STEUBLE-JOHNSON MS LPC

Table of content: MS. ELISABETH HEDWIG STEUBLE-JOHNSON MS LPC (NPI 1255467585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255467585 NPI number — MS. ELISABETH HEDWIG STEUBLE-JOHNSON MS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEUBLE-JOHNSON
Provider First Name:
ELISABETH
Provider Middle Name:
HEDWIG
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEUBLE
Provider Other First Name:
ELISABETH
Provider Other Middle Name:
HEDWIG
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1255467585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 CARPENTER LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19119-2572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-438-8910
Provider Business Mailing Address Fax Number:
215-438-0479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 STENTON AVE.
Provider Second Line Business Practice Location Address:
SUITE 1F
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-247-5400
Provider Business Practice Location Address Fax Number:
215-247-5175
Provider Enumeration Date:
02/23/2007

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: 101Y00000X , with the licence number:  PC002927 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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