Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS007361L | PA |
Y | 103TC0700X | Clinical Psychologist | PS007361L | PA |
NPI | 1003011081 |
---|---|
Provider Name | Ms. Ziona Brotleit |
First Address | Bethlehem, PA 18018-5617 |
Second Address | Bethlehem, PA 18020-9201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 08/07/2007 |