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General NPI Number Information
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NPI Number | 1598970816
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Entity Type | Organization
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Legal Business Name | ELYSE C LUBELL
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6201 HAMILTON BLVD
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City | ALLENTOWN
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State | PA
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Zip | 18106-9684
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Country | US
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Telephone | 484-553-1252
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Fax | 610-398-1949
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Provider Business Mailing Address
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Address Line | 197 WINDERMERE AVE
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City | ALLENTOWN
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State | PA
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Zip | 18104-8665
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Country | US
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Telephone | 484-553-1252
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Fax | 610-398-1949
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELYSE C LUBELL
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Credential | PHD
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Telephone | 484-553-1252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS015440
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License Number State | PA
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