Provider Demographics
NPI:1801279039
Name:FAMIGLIETTI, CHRISTOPHER (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:FAMIGLIETTI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6211
Mailing Address - Country:US
Mailing Address - Phone:484-420-6636
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 2100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6211
Practice Address - Country:US
Practice Address - Phone:484-420-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
PACW0198731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical