Basic Information
| Provider Information | |||||||||
| NPI: | 1003011081 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROTLEIT | ||||||||
| FirstName: | ZIONA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MCAT, LICENSED PSYCH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 408 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180185617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108672881 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3005 BRODHEAD RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180209201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108664661 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS007361L | PA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.