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1174299945
MARLISSA CRISTINA BANTA
LEBANON, PA
NPI
1174299945
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Former Name
MARLISSA CRISTINA AMOLE
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
103TC0700X Psychologist, Clinical
(Licence: PA PS019301)
Enumeration Date
2021-08-20
Last Update Date
2021-08-20
Business Address
Dr. MARLISSA CRISTINA BANTA PhD
1700 S LINCOLN AVE
LEBANON, PA 17042-7529
Phone number: 717-272-6621
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Mailing Address
Dr. MARLISSA CRISTINA BANTA PhD
814 FRANKLIN ST
WYOMISSING, PA 19610-3002
Phone number: 610-413-8345
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