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General NPI Number Information
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NPI Number | 1104110311
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Entity Type | Individual
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Provider Name | ANNETTE DEIGH MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 6120B WOODLAND AVENUE
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City | PHILADELPHIA
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State | PA
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Zip | 19142
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Country | US
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Telephone | 267-350-5940
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Fax | 267-597-3622
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Provider Business Mailing Address
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Address Line | 4700 WISSAHICKON AVENUE BLDG D, SUITE 118
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City | PHILADELPHIA
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State | PA
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Zip | 19144-4248
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Country | US
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Telephone | 610-597-3600
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Fax | 267-597-3622
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW016868
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License Number State | PA
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