Doctor Name: | ANGELA NICOLE BROOM |
NPI Number: | 1376814038 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.S.W. |
License Number: | 149011218 |
Business Practice Address: | 552 52nd Ave Bellwood, IL - 601041761 |
Business Phone Number: | 7089252966 |
Business Fax Number: | 7084860145 |
Mailing Address: | 552 52nd Ave, BELLWOOD |
State: | IL |
Postal Code: | 601041761 |
Phone Number: | 7089252966 |
Fax Number: | 7084860145 |
NPI Enumeration Date: | 01/25/2012 |
NPI Last Update Date: | 01/25/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149011218 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |