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General NPI Number Information
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NPI Number | 1871983320
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Entity Type | Organization
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Legal Business Name | BROOK LANE BEHAVIORAL SERVICES, INC.
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 02/17/2026
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Provider Practice Location Address
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Address Line | 4540 B-D MACK AVE
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City | FREDERICK
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State | MD
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Zip | 21701
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Country | US
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Telephone | 301-733-0330
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Fax | 301-733-4038
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Provider Business Mailing Address
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Address Line | 13121 BROOKLANE DR
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City | HAGERSTOWN
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State | MD
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Zip | 21742-1514
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Country | US
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Telephone | 301-733-0330
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Fax | 301-733-4038
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Authorized Official
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Title or Position | CFO
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Name | JOSHUA REPAC
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Credential |
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Telephone | 301-790-9351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 4010
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License Number State | MD
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