Provider Demographics
NPI:1215519673
Name:RODGERS, BROOKE EILEEN (MED, LBS)
Entity type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:EILEEN
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MED, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2420
Mailing Address - Country:US
Mailing Address - Phone:724-728-8400
Mailing Address - Fax:
Practice Address - Street 1:11269 PERRY HWY STE 131-133
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9388
Practice Address - Country:US
Practice Address - Phone:724-728-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004700172V00000X
PA1-22-60222103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No172V00000XOther Service ProvidersCommunity Health Worker