Healthcare Provider Details

I. General information

NPI: 1255069589
Provider Name (Legal Business Name): LAURE ELIZABETH DEFORGES NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2022
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 BALTIMORE PIKE STE 250
SPRINGFIELD PA
19064-3974
US

IV. Provider business mailing address

1489 BALTIMORE PIKE STE 250
SPRINGFIELD PA
19064-3974
US

V. Phone/Fax

Practice location:
  • Phone: 347-356-4130
  • Fax:
Mailing address:
  • Phone: 347-356-4130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC015575
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: