Provider Demographics
NPI:1619553518
Name:ROBINSON, BRENDA LEE (MA, LBS)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MA, LBS
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LEE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:390 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2580
Practice Address - Country:US
Practice Address - Phone:717-466-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103407037-0004Medicaid