Healthcare Provider Details

I. General information

NPI: 1023349842
Provider Name (Legal Business Name): CHANTE BROCKENBOUGH BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2010
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CHESTER PIKE
COLLINGDALE PA
19023-1820
US

IV. Provider business mailing address

2600 W 9TH ST
CHESTER PA
19013-2040
US

V. Phone/Fax

Practice location:
  • Phone: 215-303-4713
  • Fax:
Mailing address:
  • Phone: 610-497-7617
  • Fax: 610-497-7588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH008501
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: