Provider Demographics
NPI:1083801716
Name:DUBERSTEIN, SUE (LSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:DUBERSTEIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ARCH ST 5
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1300
Mailing Address - Country:US
Mailing Address - Phone:267-256-2115
Mailing Address - Fax:
Practice Address - Street 1:3801 CONSHOHOCKEN AVE
Practice Address - Street 2:SUITE 123
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19131
Practice Address - Country:US
Practice Address - Phone:215-878-2336
Practice Address - Fax:215-878-2379
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0160021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1000008810025OtherPA WELFARE
PA1000008810009Medicaid
1000008810025OtherPA WELFARE