Healthcare Provider Details

I. General information

NPI: 1932158417
Provider Name (Legal Business Name): MARTHALEE T BROD PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 HARVARD AVE BOX 155
MOUNT GRETNA PA
17064
US

IV. Provider business mailing address

222 HARVARD AVE BOX 155
MOUNT GRETNA PA
17064
US

V. Phone/Fax

Practice location:
  • Phone: 717-964-1850
  • Fax: 717-964-1850
Mailing address:
  • Phone: 717-964-1850
  • Fax: 717-964-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS007990L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: