Provider Demographics
NPI:1437693819
Name:VASSO, LORETTA M
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:M
Last Name:VASSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1125
Mailing Address - Country:US
Mailing Address - Phone:215-692-2753
Mailing Address - Fax:215-643-9800
Practice Address - Street 1:7237 HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1236
Practice Address - Country:US
Practice Address - Phone:215-692-2753
Practice Address - Fax:215-643-9800
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA467135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)