Healthcare Provider Details

I. General information

NPI: 1679297253
Provider Name (Legal Business Name): PAMELA D EGLESTON MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA EGLESTON MSW, LSW

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 W GIRARD AVE
PHILADELPHIA PA
19151-4324
US

IV. Provider business mailing address

225 S 3RD ST
PHILADELPHIA PA
19106-3910
US

V. Phone/Fax

Practice location:
  • Phone: 215-351-1463
  • Fax:
Mailing address:
  • Phone: 215-351-1463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: