Doctor Name: | MR. ROBERT JEROME BROMBERG |
NPI Number: | 1073643623 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BA, CDP |
License Number: | 34121200 |
Business Practice Address: | 306 2nd St Ne Yelm, WA - 985977647 |
Business Phone Number: | 3604002242 |
Business Fax Number: | 3604002471 |
Mailing Address: | 306 2nd St Ne, YELM |
State: | WA |
Postal Code: | 985977647 |
Phone Number: | 3604002242 |
Fax Number: | 3604002471 |
NPI Enumeration Date: | 03/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 34121200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |