Healthcare Provider Details

I. General information

NPI: 1659007045
Provider Name (Legal Business Name): PERLA BASTIEN-LARIVAUX LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 LANCASTER PIKE 1ST FLOOR PMB # 7455
READING PA
19607
US

IV. Provider business mailing address

2395 LANCASTER PIKE
READING PA
19607-2375
US

V. Phone/Fax

Practice location:
  • Phone: 862-268-9000
  • Fax:
Mailing address:
  • Phone: 862-268-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC017934
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37PC00863400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: