MEDICARE: CAROLINE CHRISTIAN BROMBERG PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP2701X	Group Psychotherapy Psychologist	2290	AL
2	103TC0700X	Clinical Psychologist	106915-01	NY
3	103T00000X	Psychologist	2290	AL
4	103TB0200X	Cognitive & Behavioral Psychologist	2290	AL
5	103TC0700X	Clinical Psychologist	2290	AL
6	103TC0700X	Clinical Psychologist	017776	NY
7	103TC1900X	Counseling Psychologist	2290	AL
8	103TF0000X	Family Psychologist	2290	AL
9	103TP0814X	Psychoanalysis Psychologist	2290	AL

General Provider Information

NPI Number	:	1447866355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE CHRISTIAN BROMBERG PSYD

Provider Business Mailing Address
First Line	:	2016 STONEGATE TRL STE 112
Second Line	:
City	:	VESTAVIA HLS
State	:	AL
Zip	:	35242-2249
Country	:	US
Telephone Number	:	205-440-6292
Fax Number	:	205-313-3177

Provider Business Practice Location Address
First Line	:	2016 STONEGATE TRL STE 112
Second Line	:
City	:	VESTAVIA HLS
State	:	AL
Zip	:	35242-2249
Country	:	US
Telephone Number	:	205-440-6292
Fax Number	:	205-313-3177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	01/02/2025

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Directions to “ CAROLINE CHRISTIAN BROMBERG PSYD” Practice Location

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