Provider Demographics
NPI:1043933104
Name:BROUGH, ALICIA CHRISTINE (MED, BCBA, LBS)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:CHRISTINE
Last Name:BROUGH
Suffix:
Gender:F
Credentials:MED, BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 TRITES AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19074-1630
Mailing Address - Country:US
Mailing Address - Phone:610-715-8101
Mailing Address - Fax:
Practice Address - Street 1:219 TRITES AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:PA
Practice Address - Zip Code:19074-1630
Practice Address - Country:US
Practice Address - Phone:610-715-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist