Provider Demographics
NPI:1922056837
Name:KEPHART, CHRISTINE A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:A
Last Name:KEPHART
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 1:1000 COMMERCE DR
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4739
Mailing Address - Country:US
Mailing Address - Phone:412-264-2155
Mailing Address - Fax:412-264-1815
Practice Address - Street 1:1000 COMMERCE DR
Practice Address - Street 2:SUITE 1002
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-4739
Practice Address - Country:US
Practice Address - Phone:412-264-2155
Practice Address - Fax:412-264-1815
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0133251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS64330OtherVALUE OPTIONS
PA800012203OtherRAILROAD MEDICARE
PA214232OtherUPMC
PA627236OtherKEYSTONE HEALTH PLAN WEST
PA800012203OtherRAILROAD MEDICARE