Provider Demographics
NPI:1841202751
Name:BROSIUS, GENE N (LPC, BCBA)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:N
Last Name:BROSIUS
Suffix:
Gender:M
Credentials:LPC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:PA
Mailing Address - Zip Code:17847-1217
Mailing Address - Country:US
Mailing Address - Phone:570-412-3046
Mailing Address - Fax:
Practice Address - Street 1:935 ROUTE 522
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9714
Practice Address - Country:US
Practice Address - Phone:570-412-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50037501OtherINDIVIDUAL