Basic Information
Provider Information
NPI: 1235446006
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PIERRE
FirstName: JOEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PMHNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 421 CHEW ST
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181023406
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 421 CHEW ST
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181023406
CountryCode: US
TelephoneNumber: 6103727712
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/01/2010
LastUpdateDate: 02/04/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/04/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XSP025271PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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