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General NPI Number Information
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NPI Number | 1609495159
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Entity Type | Individual
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Provider Name | CHRISTIE EASTBURN
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Gender | Female
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 1229 S 6TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-4837
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Country | US
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Telephone | 267-419-7574
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 HARRISON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19124-2909
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Country | US
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Telephone | 302-229-2082
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Fax |
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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 | SW131922
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License Number State | PA
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