Provider Demographics
NPI:1346655024
Name:VANDERPOOL, ROSELYNN A (LCPC, LCPAT, LPC)
Entity Type:Individual
Prefix:
First Name:ROSELYNN
Middle Name:A
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:LCPC, LCPAT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SUMMIT SQUARE CTR # 116
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1078
Mailing Address - Country:US
Mailing Address - Phone:443-840-9036
Mailing Address - Fax:301-205-5919
Practice Address - Street 1:6238 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4119
Practice Address - Country:US
Practice Address - Phone:443-840-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-21
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14467101YP2500X
MDATC063221700000X
MDLC6104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0840432-00Medicaid