Provider Demographics
NPI:1003207853
Name:BRODA, LENORA JEANNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LENORA
Middle Name:JEANNE
Last Name:BRODA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MARKET ST
Mailing Address - Street 2:DIAKON FAMILY LIFE SERVICES,
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837
Mailing Address - Country:US
Mailing Address - Phone:570-524-9477
Mailing Address - Fax:
Practice Address - Street 1:1800 MARKET ST,
Practice Address - Street 2:DIAKON FAMILY LIFE SERVICES
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837
Practice Address - Country:US
Practice Address - Phone:570-524-9477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional