Healthcare Provider Details

I. General information

NPI: 1215968458
Provider Name (Legal Business Name): CHRISTINA SOUBASIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 NAUTILUS DR
MANAHAWKIN NJ
08050-2448
US

IV. Provider business mailing address

160 ATLANTIC CITY BLVD
BAYVILLE NJ
08721-1229
US

V. Phone/Fax

Practice location:
  • Phone: 609-597-5327
  • Fax: 609-597-6684
Mailing address:
  • Phone: 732-349-1977
  • Fax: 732-349-0841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05262100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: