Provider Demographics
NPI:1750635223
Name:MAIELLO, PAMELA THERESA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:THERESA
Last Name:MAIELLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:THERESA
Other - Last Name:BONDAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 LADYBUG LN
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-3134
Mailing Address - Country:US
Mailing Address - Phone:717-274-9777
Mailing Address - Fax:717-274-9815
Practice Address - Street 1:204 HATHAWAY PARK
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6162
Practice Address - Country:US
Practice Address - Phone:717-274-9777
Practice Address - Fax:717-274-9815
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101Y00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor