Provider Demographics
NPI:1437756368
Name:LAKE, DEBRA (MS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:LAKE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5047 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOHNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19540-8130
Mailing Address - Country:US
Mailing Address - Phone:267-566-8770
Mailing Address - Fax:
Practice Address - Street 1:17 BARCLAY STREET
Practice Address - Street 2:BUILDING B3
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940
Practice Address - Country:US
Practice Address - Phone:267-566-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health