Provider Demographics
NPI:1104110311
Name:DEIGH, ANNETTE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:DEIGH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:OWENS-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4700 WISSAHICKON AVENUE
Mailing Address - Street 2:BLDG D, SUITE 118
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4248
Mailing Address - Country:US
Mailing Address - Phone:610-597-3600
Mailing Address - Fax:267-597-3622
Practice Address - Street 1:6120B WOODLAND AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142
Practice Address - Country:US
Practice Address - Phone:267-350-5940
Practice Address - Fax:267-597-3622
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0168681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical