Provider Demographics
NPI:1437569803
Name:CLEWELL, DEADRA (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:DEADRA
Middle Name:
Last Name:CLEWELL
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SINGER CT
Mailing Address - Street 2:
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-8059
Mailing Address - Country:US
Mailing Address - Phone:610-737-1236
Mailing Address - Fax:
Practice Address - Street 1:26 W BROAD ST STE 111
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5732
Practice Address - Country:US
Practice Address - Phone:610-737-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007170101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional