Provider Demographics
NPI:1275172884
Name:BERTOLINO, JESSICA (MA, MT-BC, LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BERTOLINO
Suffix:
Gender:F
Credentials:MA, MT-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6725
Mailing Address - Country:US
Mailing Address - Phone:267-584-6711
Mailing Address - Fax:
Practice Address - Street 1:570 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6725
Practice Address - Country:US
Practice Address - Phone:717-202-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional