Healthcare Provider Details

I. General information

NPI: 1487485918
Provider Name (Legal Business Name): DEIDRE LPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 PENN AVE STE 305
WYOMISSING PA
19610-2100
US

IV. Provider business mailing address

1235 PENN AVE STE 305
WYOMISSING PA
19610-2100
US

V. Phone/Fax

Practice location:
  • Phone: 484-525-0509
  • Fax:
Mailing address:
  • Phone: 484-769-2862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEIDRE LUPIA
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 484-525-0509