Provider Demographics
NPI:1003678335
Name:BERTOLETTE-RUPLEY, JUSTIN ANDREW (LCSW)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ANDREW
Last Name:BERTOLETTE-RUPLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2558 MAYFIELD ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17406-3119
Mailing Address - Country:US
Mailing Address - Phone:717-542-9459
Mailing Address - Fax:
Practice Address - Street 1:1101 EDGAR ST STE C
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2862
Practice Address - Country:US
Practice Address - Phone:717-812-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0243221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical