Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PS016347 | PA |
N | 103TC0700X | Clinical Psychologist | PS016347 | PA |
N | 103G00000X | Clinical Psychologist | PS016347 | PA |
N | 103TC0700X | Clinical Psychologist | PS016347 | PA |
Y | 103TR0400X | Rehabilitation Psychologist | PS016347 | PA |
NPI | 1497875199 |
---|---|
Provider Name | Dr. Mary Grace Brownsberger |
First Address | Allentown, PA 18103-3308 |
Second Address | Allentown, PA 18103-3308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 15/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102565855 | (05) | PA |