Healthcare Provider Details

I. General information

NPI: 1427968213
Provider Name (Legal Business Name): ANN ROSE COMPOSTELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 N 2ND ST
ALLENTOWN PA
18102-3508
US

IV. Provider business mailing address

218 N 2ND ST
ALLENTOWN PA
18102-3508
US

V. Phone/Fax

Practice location:
  • Phone: 484-640-1200
  • Fax: 484-640-1201
Mailing address:
  • Phone: 484-640-1200
  • Fax: 484-640-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: