Provider Demographics
NPI:1114069796
Name:BROOKHAVEN CENTER FOR COUNSELING AND DEVELOPMENT
Entity Type:Organization
Organization Name:BROOKHAVEN CENTER FOR COUNSELING AND DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:610-395-3005
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:FOGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18051
Mailing Address - Country:US
Mailing Address - Phone:610-395-3005
Mailing Address - Fax:
Practice Address - Street 1:2307 COVE ROAD
Practice Address - Street 2:
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051
Practice Address - Country:US
Practice Address - Phone:610-395-3005
Practice Address - Fax:610-391-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAP5 5276L103TC0700X
PAPS 5277 L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty