Provider Demographics
NPI:1679965214
Name:CHENITZ, CHRISTINE MARIE BRADLEY (LCSW-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE BRADLEY
Last Name:CHENITZ
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 E BALTIMORE PIKE # 1005
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1864
Mailing Address - Country:US
Mailing Address - Phone:484-758-0139
Mailing Address - Fax:
Practice Address - Street 1:118 GLENLOCH DR
Practice Address - Street 2:
Practice Address - City:LANDENBERG
Practice Address - State:PA
Practice Address - Zip Code:19350
Practice Address - Country:US
Practice Address - Phone:484-758-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00018021041C0700X
MD182681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEQ1-0001892OtherLICENSE - LCSW
MD18268OtherLICENSE
PACW021295OtherLICENSE - LCSW