Provider Demographics
NPI:1962719021
Name:LUSTIG, BETH ELLEN
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ELLEN
Last Name:LUSTIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 WOODTHRUSH CT
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5550
Mailing Address - Country:US
Mailing Address - Phone:215-321-4894
Mailing Address - Fax:
Practice Address - Street 1:1255 WOODTHRUSH CT
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5550
Practice Address - Country:US
Practice Address - Phone:215-321-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005938L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist