Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CW015963 | PA |
NPI | 1003064239 |
---|---|
Provider Name | Ms. Eileen Elizabeth Brumbaugh |
First Address | Lansdowne, PA 19050-2335 |
Second Address | Springfield, PA 19064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2008 |
Last Update Date | 29/08/2008 |