Healthcare Provider Details

I. General information

NPI: 1740885847
Provider Name (Legal Business Name): MICHAELYN MARIE LASORSA MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 03/30/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 E UWCHLAN AVE # 233
EXTON PA
19341-1203
US

IV. Provider business mailing address

64 E UWCHLAN AVE # 233
EXTON PA
19341-1203
US

V. Phone/Fax

Practice location:
  • Phone: 610-914-9310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC017840
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: