Healthcare Provider Details

I. General information

NPI: 1134605546
Provider Name (Legal Business Name): ELIZABETH A. TEBOH LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 NORTHAMPTON ST # 201
EASTON PA
18042-4233
US

IV. Provider business mailing address

2160 JOHNSTON DR APT 9
BETHLEHEM PA
18020-3392
US

V. Phone/Fax

Practice location:
  • Phone: 610-559-8151
  • Fax: 610-559-9056
Mailing address:
  • Phone: 484-892-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW135085
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: