Provider Demographics
NPI:1588400386
Name:CHONCEK, BRANDON JOSEPH
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JOSEPH
Last Name:CHONCEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-1240
Mailing Address - Country:US
Mailing Address - Phone:724-859-7644
Mailing Address - Fax:
Practice Address - Street 1:300 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2416
Practice Address - Country:US
Practice Address - Phone:724-545-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health