Healthcare Provider Details

I. General information

NPI: 1639014566
Provider Name (Legal Business Name): BROOKE WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 PA-940 UNIT 106
MOUNT POCONO PA
18344
US

IV. Provider business mailing address

PO BOX 47
POCONO SUMMIT PA
18346-0047
US

V. Phone/Fax

Practice location:
  • Phone: 272-219-0844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC002320
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: