Provider Demographics
NPI:1285038851
Name:GREGORY, CHRISTIN ANN (DSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:ANN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:CHRISTIN
Other - Middle Name:ANN
Other - Last Name:MARKELWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST STE 1605
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6216
Mailing Address - Country:US
Mailing Address - Phone:215-701-9420
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 1605
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6216
Practice Address - Country:US
Practice Address - Phone:215-701-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0182081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical