1154415164 NPI number — MRS. LYNNE S DICAPRIO MA

Table of content: MRS. LYNNE S DICAPRIO MA (NPI 1154415164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154415164 NPI number — MRS. LYNNE S DICAPRIO MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICAPRIO
Provider First Name:
LYNNE
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DILULLO
Provider Other First Name:
LYNNE
Provider Other Middle Name:
S
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:
1154415164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1204 HOLLY LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN MILLS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-356-2100
Provider Business Mailing Address Fax Number:
610-356-6645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 CAMPUS BLVD
Provider Second Line Business Practice Location Address:
SUITE 102 DELAWARE COUNTY PROFESSIONAL SERVICES
Provider Business Practice Location Address City Name:
NEWTOWN SQUARE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-356-2100
Provider Business Practice Location Address Fax Number:
610-356-6645
Provider Enumeration Date:
10/03/2006

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: 103T00000X , with the licence number:  PS004778L , 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)