1750635223 NPI number — MRS. PAMELA THERESA MAIELLO LMFT

Table of content: MRS. PAMELA THERESA MAIELLO LMFT (NPI 1750635223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750635223 NPI number — MRS. PAMELA THERESA MAIELLO LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAIELLO
Provider First Name:
PAMELA
Provider Middle Name:
THERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BONDAR
Provider Other First Name:
PAMELA
Provider Other Middle Name:
THERESA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750635223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 LADYBUG LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MYERSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17067-3134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-274-9777
Provider Business Mailing Address Fax Number:
717-274-9815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 HATHAWAY PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-6162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-274-9777
Provider Business Practice Location Address Fax Number:
717-274-9815
Provider Enumeration Date:
11/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  101Y00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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