Provider Demographics
NPI:1588743140
Name:LYSINGER, RACHELLE WITSIL (LCSW)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:WITSIL
Last Name:LYSINGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 PINEWIND DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALBURTIS
Mailing Address - State:PA
Mailing Address - Zip Code:18011
Mailing Address - Country:US
Mailing Address - Phone:267-374-0515
Mailing Address - Fax:610-395-5561
Practice Address - Street 1:1551 PINEWIND DRIVE
Practice Address - Street 2:
Practice Address - City:ALBURTIS
Practice Address - State:PA
Practice Address - Zip Code:18011
Practice Address - Country:US
Practice Address - Phone:267-374-0515
Practice Address - Fax:610-395-5561
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000067103K00000X
PACW0179161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst