Provider Demographics
NPI:1477959401
Name:MARTELLO, EILEEN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MARTELLO
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 SHEWELL RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1216
Mailing Address - Country:US
Mailing Address - Phone:267-444-7239
Mailing Address - Fax:
Practice Address - Street 1:6280 SHEWELL RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1216
Practice Address - Country:US
Practice Address - Phone:267-444-7239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004102101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional