Provider Demographics
NPI:1790155133
Name:RUPERT, SENEKA MARIE (MED, LMFT)
Entity Type:Individual
Prefix:
First Name:SENEKA
Middle Name:MARIE
Last Name:RUPERT
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 ELM RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-7032
Mailing Address - Country:US
Mailing Address - Phone:215-779-9117
Mailing Address - Fax:
Practice Address - Street 1:203 ELM RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-7032
Practice Address - Country:US
Practice Address - Phone:215-779-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000761106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist