=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598650111
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH ANASTASIA BROOME MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2025
-----------------------------------------------------
Last Update Date | 06/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 HAVERFORD RD
-----------------------------------------------------
City | HAVERFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19041-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-585-5035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 408 FOX CHAPEL LN
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19087-2727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-585-5035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------