Provider Demographics
NPI:1871903658
Name:STOOTHOFF, BRANDON LEE (MS, LPC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:STOOTHOFF
Suffix:
Gender:
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-3104
Mailing Address - Country:US
Mailing Address - Phone:845-594-3172
Mailing Address - Fax:
Practice Address - Street 1:523 W CHOCOLATE AVE FL 2
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1629
Practice Address - Country:US
Practice Address - Phone:845-594-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008141101YP2500X
PABH001643103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst