Healthcare Provider Details

I. General information

NPI: 1720088172
Provider Name (Legal Business Name): ROBERT CHUPELLA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E ELIZABETH AVE SUITE 27
BETHLEHEM PA
18018-6505
US

IV. Provider business mailing address

540 BRIDLE PATH RD
BETHLEHEM PA
18017-3110
US

V. Phone/Fax

Practice location:
  • Phone: 610-691-1740
  • Fax: 610-691-1740
Mailing address:
  • Phone: 610-691-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS003385L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: