Provider Demographics
NPI:1609970755
Name:LEMONCELLI, JOHN J (ED D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:LEMONCELLI
Suffix:
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SPRUCE STREET
Mailing Address - Street 2:BANK TOWERS 4TH FLOOR
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-7582
Mailing Address - Fax:570-343-5162
Practice Address - Street 1:321 SPRUCE STREET
Practice Address - Street 2:BANK TOWERS 4TH FLOOR
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503
Practice Address - Country:US
Practice Address - Phone:570-342-7582
Practice Address - Fax:570-343-5162
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005397L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2029166OtherCIGNA
411073Medicare ID - Type Unspecified
2029166OtherCIGNA