Provider Demographics
NPI:1255467585
Name:STEUBLE-JOHNSON, ELISABETH HEDWIG (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:HEDWIG
Last Name:STEUBLE-JOHNSON
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:HEDWIG
Other - Last Name:STEUBLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LPC
Mailing Address - Street 1:101 CARPENTER LANE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2572
Mailing Address - Country:US
Mailing Address - Phone:215-438-8910
Mailing Address - Fax:215-438-0479
Practice Address - Street 1:7600 STENTON AVE.
Practice Address - Street 2:SUITE 1F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118
Practice Address - Country:US
Practice Address - Phone:215-247-5400
Practice Address - Fax:215-247-5175
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002927101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor