Provider Demographics
NPI:1154580991
Name:DEPATHY, CHRISTINA ELIZABETH (LICSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:DEPATHY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SUMMER ST
Mailing Address - Street 2:SUITE 202 A
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3469
Mailing Address - Country:US
Mailing Address - Phone:508-207-8819
Mailing Address - Fax:508-884-2476
Practice Address - Street 1:35 SUMMER ST
Practice Address - Street 2:SUITE 202 A
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3469
Practice Address - Country:US
Practice Address - Phone:508-207-8819
Practice Address - Fax:508-884-2476
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3132361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical