Provider Demographics
NPI:1326206798
Name:VANDERHALL, DAMARIS (LCSW)
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:VANDERHALL
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 1:42 FREEDOM TER
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-7442
Mailing Address - Country:US
Mailing Address - Phone:484-522-0853
Mailing Address - Fax:
Practice Address - Street 1:2061 FAIRVIEW AVE
Practice Address - Street 2:STE 2
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3953
Practice Address - Country:US
Practice Address - Phone:484-246-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-01
Last Update Date:2022-02-01
Deactivation Date:2018-09-07
Deactivation Code:
Reactivation Date:2018-09-25
Provider Licenses
StateLicense IDTaxonomies
PACW0201431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW020143OtherLCSW