Provider Demographics
NPI:1750095923
Name:MICCIULLA, ELIZABETH (LPC, ATR-BC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MICCIULLA
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 SPUR RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2610
Mailing Address - Country:US
Mailing Address - Phone:609-647-7956
Mailing Address - Fax:
Practice Address - Street 1:4920 YORK ROAD
Practice Address - Street 2:SUITE 2FF
Practice Address - City:BUCKINGHAM
Practice Address - State:PA
Practice Address - Zip Code:18912
Practice Address - Country:US
Practice Address - Phone:215-550-1851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01080000101Y00000X
PA18077101YA0400X
PAPC017185101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
23-491OtherATR-BC ART THERAPIST
PA18077OtherCAADC