Individual
DR. MARLISSA CRISTINA BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1700 S LINCOLN AVE, LEBANON, PA 17042-7529
(717) 272-6621
Mailing address
814 FRANKLIN ST, WYOMISSING, PA 19610-3002
(610) 413-8345
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS019301
PA
Other
Enumeration date
08/20/2021
Last updated
08/20/2021
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