Healthcare Provider Details

I. General information

NPI: 1699847392
Provider Name (Legal Business Name): PINEBROOK FAMILY ANSWERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NORTHAMPTON ST STE 201
EASTON PA
18042-4152
US

IV. Provider business mailing address

402 N FULTON ST
ALLENTOWN PA
18102-2002
US

V. Phone/Fax

Practice location:
  • Phone: 610-559-8151
  • Fax: 610-559-9056
Mailing address:
  • Phone: 610-432-3919
  • Fax: 610-432-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number204540
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LESLIE TENBROECK
Title or Position: VP
Credential:
Phone: 610-774-1434