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General NPI Number Information
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NPI Number | 1245651157
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Entity Type | Individual
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Provider Name | MARK BRANDEBURA
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Gender | Male
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 6315 FORBES AVE
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City | PITTSBURGH
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State | PA
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Zip | 15217-1745
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Country | US
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Telephone | 412-983-6616
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Fax |
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Provider Business Mailing Address
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Address Line | 912 KENNEDY ST REAR
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City | CARNEGIE
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State | PA
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Zip | 15106-3163
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Country | US
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Telephone | 412-983-6616
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC007218
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License Number State | PA
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