=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639014566
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BROOKE WEISS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2026
-----------------------------------------------------
Last Update Date | 04/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3041 PA-940 UNIT 106
-----------------------------------------------------
City | MOUNT POCONO
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 272-219-0844
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 47
-----------------------------------------------------
City | POCONO SUMMIT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18346-0047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | APC002320
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------