Healthcare Provider Details

I. General information

NPI: 1164684718
Provider Name (Legal Business Name): DAVID BROMBERG PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20134 VALLEY FORGE CIR
KING OF PRUSSIA PA
19406-1112
US

IV. Provider business mailing address

93 MACINTOSH CT
HORSHAM PA
19044-1992
US

V. Phone/Fax

Practice location:
  • Phone: 610-878-9330
  • Fax: 267-552-1002
Mailing address:
  • Phone: 215-479-6686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS009169L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS009169L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPS009169L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS009169L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: