Provider Demographics
NPI:1063034981
Name:BROWNDORF, MELANIE S (LPC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:S
Last Name:BROWNDORF
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 1:11 POPLAR CT
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3219
Mailing Address - Country:US
Mailing Address - Phone:215-704-4274
Mailing Address - Fax:267-759-6883
Practice Address - Street 1:11 POPLAR CT
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3219
Practice Address - Country:US
Practice Address - Phone:215-704-4274
Practice Address - Fax:267-759-6883
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00663700101YP2500X
PAPC012146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA85-0882225OtherAPPLIED ON LINE FOR INFINITYAATS.COM MY BUSINESS