Healthcare Provider Details

I. General information

NPI: 1861680845
Provider Name (Legal Business Name): AMY P. BROM PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY A. PITTS

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WEEOT WAY
ARCATA CA
95521-4734
US

IV. Provider business mailing address

6 TARMAN DR
CLOVERDALE CA
95425-3932
US

V. Phone/Fax

Practice location:
  • Phone: 707-825-5000
  • Fax: 707-825-6747
Mailing address:
  • Phone: 707-894-4229
  • Fax: 707-894-2954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY22123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: