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General NPI Number Information
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NPI Number | 1528548609
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Entity Type | Individual
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Provider Name | ROBIN BROMBERG LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 30 WALLINGFORD RD
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City | BRIGHTON
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State | MA
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Zip | 02135-4708
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Country | US
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Telephone | 617-912-8487
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Fax |
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Provider Business Mailing Address
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Address Line | 68 PRESTON ST APT 7A
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City | WAKEFIELD
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State | MA
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Zip | 01880-2564
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Country | US
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Telephone | 781-718-4815
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1025402
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License Number State | MA
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