Provider Demographics
NPI:1699847392
Name:PINEBROOK FAMILY ANSWERS
Entity Type:Organization
Organization Name:PINEBROOK FAMILY ANSWERS
Other - Org Name:THE FLORENCE CHILD GUIDANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TENBROECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-774-1434
Mailing Address - Street 1:402 N FULTON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-2002
Mailing Address - Country:US
Mailing Address - Phone:610-432-3919
Mailing Address - Fax:610-432-5174
Practice Address - Street 1:1101 NORTHAMPTON ST STE 201
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4152
Practice Address - Country:US
Practice Address - Phone:610-559-8151
Practice Address - Fax:610-559-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
PA204540261QM0855X
PA203800261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100759368Medicaid
PA29-1501260OtherCBHNP
PA1000570OtherCCBH
PA802495000OtherMAGELLAN - EASTON SITE
PA265638000OtherMAGELLAN - ALLENTOWN SITE