Provider Demographics
NPI:1184652844
Name:SCHIPPELL, PAMELA L (PHD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:SCHIPPELL
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 1:1320 HAUSMAN RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9056
Mailing Address - Country:US
Mailing Address - Phone:484-273-2523
Mailing Address - Fax:
Practice Address - Street 1:1320 HAUSMAN RD STE 202
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9056
Practice Address - Country:US
Practice Address - Phone:484-273-2523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015512103T00000X
PAPS017214103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02597015Medicaid
NYQ32499Medicare UPIN
NY02597015Medicaid