Provider Demographics
NPI:1346670254
Name:URBINE, WILLIAM (MED, LMFT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:URBINE
Suffix:
Gender:M
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1351
Mailing Address - Country:US
Mailing Address - Phone:610-838-2880
Mailing Address - Fax:610-838-2781
Practice Address - Street 1:1422 MAIN ST
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1351
Practice Address - Country:US
Practice Address - Phone:610-838-2880
Practice Address - Fax:610-838-2781
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000205101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12590476OtherCAQH