Provider Demographics
NPI:1215693593
Name:RETAMAR, MARIA SOLEDAD (LPC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:SOLEDAD
Last Name:RETAMAR
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 1:1442 POTTSTOWN PIKE UNIT 3043
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1271
Mailing Address - Country:US
Mailing Address - Phone:484-784-8620
Mailing Address - Fax:
Practice Address - Street 1:1442 POTTSTOWN PIKE UNIT 3043
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-1271
Practice Address - Country:US
Practice Address - Phone:484-784-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional