Healthcare Provider Details

I. General information

NPI: 1639387665
Provider Name (Legal Business Name): MARLEE LYNN STEFANELLI MS, LPC, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 MAIN ST
BLAKELY PA
18447-1362
US

IV. Provider business mailing address

1714 MAIN ST
BLAKELY PA
18447-1362
US

V. Phone/Fax

Practice location:
  • Phone: 570-954-7181
  • Fax: 570-489-1464
Mailing address:
  • Phone: 570-954-7181
  • Fax: 570-489-1464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004617
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN000351
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: