Basic Information
Provider Information
NPI: 1003079880
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALBAN
FirstName: BRYNNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.ED.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 N 7TH ST
Address2:  
City: LEBANON
State: PA
PostalCode: 170465040
CountryCode: US
TelephoneNumber: 7172731710
FaxNumber: 7172731416
Practice Location
Address1: 938 PENN ST
Address2:  
City: READING
State: PA
PostalCode: 196021717
CountryCode: US
TelephoneNumber: 6104788088
FaxNumber: 6104784884
Other Information
ProviderEnumerationDate: 07/02/2008
LastUpdateDate: 07/02/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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