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General NPI Number Information
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NPI Number | 1427324169
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Entity Type | Organization
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Legal Business Name | BROOKE E. EGBERT, PSY.D., LLC
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/08/2013
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Provider Practice Location Address
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Address Line | 1325 N RIVER ST SUITE 206
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City | PLAINS
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State | PA
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Zip | 18702-1838
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Country | US
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Telephone | 570-899-8902
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Fax | 570-824-5417
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Provider Business Mailing Address
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Address Line | 1325 N RIVER ST SUITE 206
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City | PLAINS
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State | PA
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Zip | 18702-1838
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Country | US
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Telephone | 570-899-8902
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Fax | 570-824-5417
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. BROOKE EGBERT
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Credential | PSY.D.
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Telephone | 570-899-8902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS016379
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS016379
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License Number State | PA
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