Healthcare Provider Details

I. General information

NPI: 1194931923
Provider Name (Legal Business Name): BETH D GAMBURG CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 EDGMONT AVE
CHESTER PA
19013-3944
US

IV. Provider business mailing address

1450 EDGMONT AVE
CHESTER PA
19013-3944
US

V. Phone/Fax

Practice location:
  • Phone: 610-499-1780
  • Fax: 610-499-7190
Mailing address:
  • Phone: 610-499-1780
  • Fax: 610-499-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013883
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: