Provider Demographics
NPI:1558663047
Name:CULBERSON, EMMA GRACE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EMMA
Middle Name:GRACE
Last Name:CULBERSON
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 1:125 RUTH ST APT 321
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15211-2378
Mailing Address - Country:US
Mailing Address - Phone:412-296-1812
Mailing Address - Fax:
Practice Address - Street 1:500 GRANT ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-2502
Practice Address - Country:US
Practice Address - Phone:412-296-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0168021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1558663047OtherGERIATRICS