Healthcare Provider Details

I. General information

NPI: 1083801716
Provider Name (Legal Business Name): SUE DUBERSTEIN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 CONSHOHOCKEN AVE SUITE 123
PHILA PA
19131
US

IV. Provider business mailing address

2100 ARCH ST 5
PHILADELPHIA PA
19103-1300
US

V. Phone/Fax

Practice location:
  • Phone: 215-878-2336
  • Fax: 215-878-2379
Mailing address:
  • Phone: 267-256-2115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016002
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: