MEDICARE: STEPHANIE IANNUCCI LPC, LBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC007668	PA

General Provider Information

NPI Number	:	1285040493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE IANNUCCI LPC, LBS

Provider Business Mailing Address
First Line	:	450 PARKWAY
Second Line	:	SUITE 204
City	:	BROOMALL
State	:	PA
Zip	:	19008-4202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 PARKWAY
Second Line	:	#204
City	:	BROOMALL
State	:	PA
Zip	:	19008-4202
Country	:	US
Telephone Number	:	610-715-9613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	08/29/2014

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