Provider Demographics
NPI:1508319484
Name:SEPONARA, ALISON KATE
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:KATE
Last Name:SEPONARA
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 1:1630 GOVERNORS WAY
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2553
Mailing Address - Country:US
Mailing Address - Phone:610-952-3050
Mailing Address - Fax:
Practice Address - Street 1:5 EVERGREEN AVE
Practice Address - Street 2:FRONT OFFICE
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4703
Practice Address - Country:US
Practice Address - Phone:214-284-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional