Provider Demographics
NPI:1528280757
Name:GEPHART, CHRISTINE ANGELA (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANGELA
Last Name:GEPHART
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1444
Mailing Address - Country:US
Mailing Address - Phone:585-502-6025
Mailing Address - Fax:585-502-5213
Practice Address - Street 1:71 MAIN ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1444
Practice Address - Country:US
Practice Address - Phone:585-502-6025
Practice Address - Fax:585-502-5213
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055014-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical