Healthcare Provider Details

I. General information

NPI: 1851665715
Provider Name (Legal Business Name): LORI KONITSKY CHAPLICK M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S CENTRE AVE SUITE A5
LEESPORT PA
19533-8653
US

IV. Provider business mailing address

50 MOORENOLL ST
SCHUYLKILL HAVEN PA
17972-2019
US

V. Phone/Fax

Practice location:
  • Phone: 215-939-8429
  • Fax: 610-926-9179
Mailing address:
  • Phone: 570-385-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: