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General NPI Number Information
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NPI Number | 1689182560
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Entity Type | Individual
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Provider Name | DEIDRE LUPIA
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Gender | Female
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Dates
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Enumeration Date | 01/13/2018
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Last Update Date | 09/29/2024
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Provider Practice Location Address
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Address Line | 1235 PENN AVE STE 305
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City | WYOMISSING
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State | PA
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Zip | 19610-2100
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Country | US
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Telephone | 484-525-0509
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 PENN AVE STE 305
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City | WYOMISSING
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State | PA
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Zip | 19610-2100
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Country | US
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Telephone | 484-525-0509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | PC013761
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC013761
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC013761
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License Number State | PA
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