Provider Demographics
NPI:1164256863
Name:DEPAULA, LISETTE MARIA
Entity type:Individual
Prefix:MS
First Name:LISETTE
Middle Name:MARIA
Last Name:DEPAULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8479
Mailing Address - Country:US
Mailing Address - Phone:610-751-4357
Mailing Address - Fax:
Practice Address - Street 1:1 E BROAD ST STE 510
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5964
Practice Address - Country:US
Practice Address - Phone:610-865-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000285101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional