Provider Demographics
NPI:1245645571
Name:VANDAMIA, ELISE MARITA (EDD, LPC)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:MARITA
Last Name:VANDAMIA
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 WINDOVER DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-9395
Mailing Address - Country:US
Mailing Address - Phone:724-298-8455
Mailing Address - Fax:
Practice Address - Street 1:807 WINDOVER DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:PA
Practice Address - Zip Code:15071-9395
Practice Address - Country:US
Practice Address - Phone:724-298-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006158101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional