Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC006064 | PA |
NPI | 1003207853 |
---|---|
Provider Name | Ms. Lenora Jeanne Broda |
First Address | Lewisburg, PA 17837 |
Second Address | Lewisburg, PA 17837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2015 |
Last Update Date | 16/02/2015 |