Provider Demographics
NPI:1598970816
Name:ELYSE C LUBELL
Entity Type:Organization
Organization Name:ELYSE C LUBELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:484-553-1252
Mailing Address - Street 1:197 WINDERMERE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-8665
Mailing Address - Country:US
Mailing Address - Phone:484-553-1252
Mailing Address - Fax:610-398-1949
Practice Address - Street 1:6201 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9684
Practice Address - Country:US
Practice Address - Phone:484-553-1252
Practice Address - Fax:610-398-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015440103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1918086OtherHIGHMARK BLUE SHIELD
PA50049223OtherCAPITAL BLUE CROSS
PAG3543672OtherOXFORD HEALTH
PA50049223OtherCAPITAL BLUE CROSS