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General NPI Number Information
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NPI Number | 1922814615
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Entity Type | Individual
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Provider Name | KATY EUSTIS LMSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 1120 W TOWNSHIP LINE RD STE 101
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City | HAVERTOWN
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State | PA
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Zip | 19083-4930
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Country | US
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Telephone | 610-708-0721
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Fax |
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Provider Business Mailing Address
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Address Line | 1513 N 29TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19121-3620
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Country | US
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Telephone | 202-352-1099
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 108302-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW140559
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License Number State | PA
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