1639836539 NPI number — YAMISEL MARTINEZ-MOLINA LPC

Table of content: YAMISEL MARTINEZ-MOLINA LPC (NPI 1639836539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639836539 NPI number — YAMISEL MARTINEZ-MOLINA LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ-MOLINA
Provider First Name:
YAMISEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639836539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 RIDGE PIKE APT 211B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE HILL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19444-1917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-769-7049
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
752 WILLOW ST STE G
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:
17046-5066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-269-6572
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2021

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: 101YP2500X , with the licence number:  PC013887 , 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)