Provider Demographics
NPI:1205235009
Name:STEPHAN BROOKENS
Entity type:Organization
Organization Name:STEPHAN BROOKENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED BEHAVIOR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:SAFON
Authorized Official - Last Name:BROOKENS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:484-938-8732
Mailing Address - Street 1:1554 E WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-1608
Mailing Address - Country:US
Mailing Address - Phone:484-938-8732
Mailing Address - Fax:
Practice Address - Street 1:1554 E WALNUT LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-1608
Practice Address - Country:US
Practice Address - Phone:484-938-8732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001289251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health