Marlissa Cristina Banta, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS019301 Issued in PA

Practice address

1700 S Lincoln Ave
Lebanon, PA 17042-7529

Phone

(717) 272-6621

NPI assigned

Aug 20, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Marlissa Cristina Amole Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629417600000",
    "number": "1174299945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 FRANKLIN ST",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196103002",
            "telephone_number": "610-413-8345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 S LINCOLN AVE",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427529",
            "telephone_number": "717-272-6621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANTA",
        "first_name": "MARLISSA",
        "middle_name": "CRISTINA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-20",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS019301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARLISSA",
            "last_name": "AMOLE",
            "middle_name": "CRISTINA",
            "prefix": "DR.",
            "credential": "PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alexandre Balaci, DMD
• Dawn Baldwin
• Melissa Baldwin, CRNP
• Robert J Balogh Jr., MD
• Rikka Asuncion Banayat, M.D.
• Chrisopher John Baptiste, LPC
• Wendy Yvonne Baran-Gonzalez, RN BSN
• Barbara a. Klatchko, M.D., LTD.
• Diana Barco
• Katie Harper Barlup, LSW

• Clinical Psychologist in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Clinical Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.