Provider Demographics
NPI:1194931923
Name:GAMBURG, BETH D (CSW)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:D
Last Name:GAMBURG
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3944
Mailing Address - Country:US
Mailing Address - Phone:610-499-1780
Mailing Address - Fax:610-499-7190
Practice Address - Street 1:1450 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3944
Practice Address - Country:US
Practice Address - Phone:610-499-1780
Practice Address - Fax:610-499-7190
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0138831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP82978Medicare UPIN
PA067536Medicare ID - Type Unspecified