Provider Demographics
NPI:1144254400
Name:LUBELL, ELYSE C (PHD)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:C
Last Name:LUBELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 WINDERMERE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104
Mailing Address - Country:US
Mailing Address - Phone:484-553-1252
Mailing Address - Fax:610-398-1949
Practice Address - Street 1:6201 HAMILTON BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:484-553-1252
Practice Address - Fax:610-398-1949
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015440103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2312064000OtherBLUE SHIELD PERSONAL CHOI
PA1637239OtherBLUE SHIELD HIGHMARK
PAG3543673OtherOXFORD HEALTH
PA50058544OtherBLUE SHIELD CAPITAL
PAG3543673OtherOXFORD HEALTH