Provider Demographics
NPI:1093104572
Name:FOR HOPE - DORY BRONGER, LICSW, PLLC
Entity Type:Organization
Organization Name:FOR HOPE - DORY BRONGER, LICSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BRONGER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-779-9460
Mailing Address - Street 1:1405 SW 296TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-3411
Mailing Address - Country:US
Mailing Address - Phone:206-779-9460
Mailing Address - Fax:
Practice Address - Street 1:33507 9TH AVE S
Practice Address - Street 2:STE. C-2
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6397
Practice Address - Country:US
Practice Address - Phone:253-363-9076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00009554305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service