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General NPI Number Information
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NPI Number | 1710012836
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Entity Type | Individual
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Provider Name | REBECCA BROOME LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 05/14/2020
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Provider Practice Location Address
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Address Line | 8010 GRAND RIVER RD STE 100
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City | BRIGHTON
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State | MI
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Zip | 48114-9303
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Country | US
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Telephone | 810-207-5725
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Fax |
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Provider Business Mailing Address
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Address Line | 10335 CEDARCREST RD
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City | WHITMORE LAKE
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State | MI
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Zip | 48189-9396
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Country | US
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Telephone | 810-207-5725
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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 | 6801088507
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License Number State | MI
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