MEDICARE: MS. EMMA GRACE CULBERSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW016802	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1558663047	OTHER	PA	GERIATRICS

General Provider Information

NPI Number	:	1558663047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMMA GRACE CULBERSON LCSW

Provider Business Mailing Address
First Line	:	125 RUTH ST APT 321
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15211-2378
Country	:	US
Telephone Number	:	412-296-1812
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 GRANT ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15219-2502
Country	:	US
Telephone Number	:	412-296-1812
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2010
Last Update Date	:	04/11/2018

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