Provider Demographics
NPI:1003342080
Name:IDA ANDREA OLMEDA
Entity Type:Organization
Organization Name:IDA ANDREA OLMEDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:IDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLMEDA
Authorized Official - Suffix:
Authorized Official - Credentials:PRE-LICENSED
Authorized Official - Phone:610-439-2700
Mailing Address - Street 1:1700 HANOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-2451
Mailing Address - Country:US
Mailing Address - Phone:484-357-7599
Mailing Address - Fax:610-439-8004
Practice Address - Street 1:1700 HANOVER AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-2451
Practice Address - Country:US
Practice Address - Phone:484-357-7599
Practice Address - Fax:610-439-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPRE-LICENSE101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty