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NPI Code Detail

MEDICARE: DR. AMY P. BROM PSY.D.

MEDICARE: DR. AMY P. BROM PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist651209MS
2103TH0100XHealth Service PsychologistPSY22123CA

General Provider Information

NPI Number : 1861680845
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY P. BROM PSY.D.
Provider Business Mailing Address
First Line : 6 TARMAN DR
Second Line :
City : CLOVERDALE
State : CA
Zip : 95425-3932
Country : US
Telephone Number : 707-894-4229
Fax Number : 707-894-2954
Provider Business Practice Location Address
First Line : 1600 WEEOT WAY
Second Line :
City : ARCATA
State : CA
Zip : 95521-4734
Country : US
Telephone Number : 707-825-5000
Fax Number : 707-825-6747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2007
Last Update Date : 03/13/2026

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