Provider Demographics
NPI:1043901374
Name:MAISONET, EVETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:EVETTE
Middle Name:
Last Name:MAISONET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-0688
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:2710 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-3574
Practice Address - Country:US
Practice Address - Phone:610-297-7500
Practice Address - Fax:610-297-7533
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0238801041C0700X
PASW134654104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical