Healthcare Provider Details

I. General information

NPI: 1790616191
Provider Name (Legal Business Name): BALANCED BRAIN NP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 NEW BRITAIN RD STE 120
DOYLESTOWN PA
18901-2992
US

IV. Provider business mailing address

390 COMMERCE DR
FORT WASHINGTON PA
19034-2600
US

V. Phone/Fax

Practice location:
  • Phone: 267-727-2697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA ODONNELL
Title or Position: PMHNP/OWNER
Credential: NP
Phone: 267-471-0431