Basic Information
| Provider Information | |||||||||
| NPI: | 1003207853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRODA | ||||||||
| FirstName: | LENORA | ||||||||
| MiddleName: | JEANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 MARKET ST | ||||||||
| Address2: | DIAKON FAMILY LIFE SERVICES, | ||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705249477 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1800 MARKET ST, | ||||||||
| Address2: | DIAKON FAMILY LIFE SERVICES | ||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705249477 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2015 | ||||||||
| LastUpdateDate: | 02/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PC006064 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.