Provider Demographics
NPI:1790227247
Name:DELULLO, ELIZABETH SUSAN (LPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:DELULLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-6749
Mailing Address - Country:US
Mailing Address - Phone:814-389-6346
Mailing Address - Fax:
Practice Address - Street 1:111 QUARRY RD
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-6749
Practice Address - Country:US
Practice Address - Phone:814-398-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA009301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional