Healthcare Provider Details

I. General information

NPI: 1154660207
Provider Name (Legal Business Name): STEVEN BROTMAN B.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2013
Last Update Date: 02/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N EASTERN AVE STE 120
LAS VEGAS NV
89101-2885
US

IV. Provider business mailing address

730 N EASTERN AVE STE 120
LAS VEGAS NV
89101-2885
US

V. Phone/Fax

Practice location:
  • Phone: 702-772-4864
  • Fax:
Mailing address:
  • Phone: 702-772-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: