Healthcare Provider Details

I. General information

NPI: 1922056837
Provider Name (Legal Business Name): CHRISTINE A KEPHART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COMMERCE DR SUITE 1002
CORAOPOLIS PA
15108-4739
US

IV. Provider business mailing address

1000 COMMERCE DR SUITE 1002
CORAOPOLIS PA
15108-4739
US

V. Phone/Fax

Practice location:
  • Phone: 412-264-2155
  • Fax: 412-264-1815
Mailing address:
  • Phone: 412-264-2155
  • Fax: 412-264-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013325
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierS64330
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerVALUE OPTIONS
# 2
Identifier800012203
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRAILROAD MEDICARE
# 3
Identifier214232
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC
# 4
Identifier627236
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE HEALTH PLAN WEST

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: