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General NPI Number Information
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NPI Number | 1679965214
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Entity Type | Individual
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Provider Name | CHRISTINE MARIE BRADLEY CHENITZ LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 118 GLENLOCH DR
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City | LANDENBERG
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State | PA
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Zip | 19350
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Country | US
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Telephone | 484-758-0139
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Fax |
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Provider Business Mailing Address
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Address Line | 873 E BALTIMORE PIKE # 1005
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City | KENNETT SQUARE
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State | PA
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Zip | 19348-1864
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Country | US
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Telephone | 484-758-0139
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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 | Q1-0001802
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 18268
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License Number State | MD
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