Provider Demographics
NPI:1336453539
Name:BRAZIL, AMANITA LUBA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANITA
Middle Name:LUBA
Last Name:BRAZIL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 W DONEGAL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-2220
Mailing Address - Country:US
Mailing Address - Phone:814-450-3012
Mailing Address - Fax:
Practice Address - Street 1:68 W DONEGAL ST
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-2220
Practice Address - Country:US
Practice Address - Phone:814-450-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist