1750095923 NPI number — ELIZABETH MICCIULLA LPC, ATR-BC

Table of content: ELIZABETH MICCIULLA LPC, ATR-BC (NPI 1750095923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750095923 NPI number — ELIZABETH MICCIULLA LPC, ATR-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICCIULLA
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, ATR-BC
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:
1750095923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1608 SPUR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YARDLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19067-2610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-647-7956
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 YORK ROAD
Provider Second Line Business Practice Location Address:
SUITE 2FF
Provider Business Practice Location Address City Name:
BUCKINGHAM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-550-1851
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2023

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:  37PC01080000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 18077 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: PC017185 , 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)

  • Identifier: 23-491 . This is a "ATR-BC ART THERAPIST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18077 . This is a "CAADC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".