Healthcare Provider Details

I. General information

NPI: 1659694677
Provider Name (Legal Business Name): MARLEE STEFANELLI GEN PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 01/08/2019
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 TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004628
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN000351
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004617
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. MARLEE L. STEFANELLI
Title or Position: OWNER
Credential: MS, LPC
Phone: 570-954-7181