Provider Demographics
NPI:1063453678
Name:LICHSTEIN, JEAN ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:LICHSTEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 WELSH RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6357
Mailing Address - Country:US
Mailing Address - Phone:215-914-2119
Mailing Address - Fax:215-914-1663
Practice Address - Street 1:727 WELSH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6357
Practice Address - Country:US
Practice Address - Phone:215-914-2119
Practice Address - Fax:215-914-1663
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW003036L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PWPD8603Medicare UPIN
PA038690N5MMedicare ID - Type Unspecified