Provider Demographics
NPI:1407158512
Name:BRUMBAUGH, MARTIN GEORGE (LSW)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:GEORGE
Last Name:BRUMBAUGH
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W HIGH ST
Mailing Address - Street 2:LOFT 600
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-1301
Mailing Address - Country:US
Mailing Address - Phone:814-353-4444
Mailing Address - Fax:814-353-4443
Practice Address - Street 1:221 W HIGH ST
Practice Address - Street 2:LOFT 600
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1301
Practice Address - Country:US
Practice Address - Phone:814-353-4444
Practice Address - Fax:814-353-4443
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128103104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker