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General NPI Number Information
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NPI Number | 1871196667
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Entity Type | Individual
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Provider Name | CHRISTOPHER LEE STOUGH LSW
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Gender | Male
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 3025 JACKS RUN ROAD PARKSIDE BUILDING ONE SUITE 5
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City | WHITE OAK
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State | PA
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Zip | 15131-1513
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Country | US
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Telephone | 412-385-7139
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Fax | 412-896-5451
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Provider Business Mailing Address
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Address Line | 3025 JACKS RUN RD PARKSIDE BUILDING ONE, SUITE 5
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City | WHITE OAK
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State | PA
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Zip | 15131-2549
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Country | US
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Telephone | 412-385-7139
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Fax | 412-896-5451
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW132322
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License Number State | PA
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