Provider Demographics
NPI:1164807046
Name:ELLENBAUM, MARGUERITE KEARNEY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARGUERITE
Middle Name:KEARNEY
Last Name:ELLENBAUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:ELLENBAUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:101 PHOENIXVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 PHOENIXVILLE PIKE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1046
Practice Address - Country:US
Practice Address - Phone:445-444-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129575104100000X
PACW0194121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker