Provider Demographics
NPI:1558786855
Name:WYFFELS, MARC S (MED, LBS)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:S
Last Name:WYFFELS
Suffix:
Gender:M
Credentials:MED, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1568
Mailing Address - Country:US
Mailing Address - Phone:484-764-1721
Mailing Address - Fax:
Practice Address - Street 1:1405 N CEDAR CREST BLVD STE 105
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2308
Practice Address - Country:US
Practice Address - Phone:610-435-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-23
Last Update Date:2014-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000627103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst