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NPI Code Detail

MEDICARE: KELLY BRUBAKER LMFT

MEDICARE: KELLY BRUBAKER LMFT
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 TherapistMF001069PA

General Provider Information

NPI Number : 1962797944
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY BRUBAKER LMFT
Provider Business Mailing Address
First Line : 2395 LANCASTER PIKE FL 1
Second Line :
City : READING
State : PA
Zip : 19607-2375
Country : US
Telephone Number : 610-909-2280
Fax Number :
Provider Business Practice Location Address
First Line : 2395 LANCASTER PIKE FL 1
Second Line :
City : READING
State : PA
Zip : 19607-2375
Country : US
Telephone Number : 484-202-3858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2011
Last Update Date : 04/03/2024

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