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General NPI Number Information
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NPI Number | 1235311655
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Entity Type | Individual
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Provider Name | LINDA R. BROBERG LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 400 FORT HILL AVE
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1159
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Country | US
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Telephone | 585-393-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 73 AUTHORS AVE
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City | HENRIETTA
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State | NY
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Zip | 14467-9329
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 073995-1
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License Number State | NY
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