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General NPI Number Information
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NPI Number | 1780070243
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Entity Type | Organization
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Legal Business Name | HEATHERMARIE SPORTELLI
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Dates
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Enumeration Date | 04/11/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 529 SEVEN BRIDGE RD SUITE 207
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-7937
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Country | US
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Telephone | 570-730-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 529 SEVEN BRIDGE RD SUITE 207
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-7937
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Country | US
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Telephone | 570-730-1234
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | HEATHER MARIE SPORTELLI
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Credential | NCC, LPC
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Telephone | 570-730-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC008010
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License Number State | PA
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