Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Masonic Villages of the Grand Lodge of Pennsylvania

Organization Psychologist · NPI 1720332653

Masonic Villages of the Grand Lodge of Pennsylvania is a Psychologist in Elizabethtown, Pennsylvania. Licensed in Pennsylvania. Registered with an NPI since 2012.

Licensed in
PA
In the registry since
2012
Specialties on file
8

Practice location Address checks out

581 Freemason Dr
Elizabethtown, PA 17022-3187
Phone: (717) 367-1121
Fax: (717) 367-5813
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Skilled Nursing Facility (primary) Taxonomy 314000000X · Licence 131502 (PA)
Psychologist Taxonomy 103T00000X
Dentist Taxonomy 122300000X
Optometrist Taxonomy 152W00000X
Ophthalmology Physician Taxonomy 207W00000X
Psychiatry Physician Taxonomy 2084P0800X
Podiatrist Taxonomy 213E00000X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1720332653
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Pamela Formica — Chief Financial Officer · (717) 367-1121
Other names Masonic Village At Elizabethtown; Masonic Village At Elizabethtown
NPI enumeratedOctober 30, 2012
Last updated in NPPESMay 1, 2023
Certification dateMay 1, 2023
Mailing address1 Masonic Dr, Elizabethtown, PA 17022-2199

Other providers in Elizabethtown