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NPI Code Detail

MEDICARE: PETA XAVIER LPC, LBS

MEDICARE: PETA XAVIER LPC, LBS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorPC019839PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114917473OTHERCAQH
2BH001357OTHERPASTATE LICENSE
3PC019839OTHERPACOUNSELING

General Provider Information

NPI Number : 1972126415
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETA XAVIER LPC, LBS
Provider Business Mailing Address
First Line : 845 N PARK RD STE 101
Second Line :
City : WYOMISSING
State : PA
Zip : 19610-1342
Country : US
Telephone Number : 845-235-1466
Fax Number :
Provider Business Practice Location Address
First Line : 239 S BUTLER RD
Second Line :
City : LEBANON
State : PA
Zip : 17042-8939
Country : US
Telephone Number : 717-270-2422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2020
Last Update Date : 03/16/2026

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Directions to “ PETA XAVIER LPC, LBS” Practice Location

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