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NPI Code Detail

MEDICARE: MS. CLOTILDA BROKAW HEIMBUCH M.S.

MEDICARE: MS. CLOTILDA BROKAW HEIMBUCH M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMF000380PA
2106H00000XMarriage & Family TherapistMF23577CA

General Provider Information

NPI Number : 1629126867
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CLOTILDA BROKAW HEIMBUCH M.S.
Provider Business Mailing Address
First Line : 300 MOUNT LEBANON BLVD STE 206
Second Line :
City : PITTSBURGH
State : PA
Zip : 15234-1507
Country : US
Telephone Number : 412-563-0650
Fax Number :
Provider Business Practice Location Address
First Line : 300 MOUNT LEBANON BLVD
Second Line : 2214
City : PITTSBURGH
State : PA
Zip : 15234-1512
Country : US
Telephone Number : 412-563-0650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2007
Last Update Date : 10/09/2025

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