Provider Demographics
NPI:1114166956
Name:BROTMAN, ADAM HUGH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:HUGH
Last Name:BROTMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5579 N TURRET WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3230
Mailing Address - Country:US
Mailing Address - Phone:503-201-6250
Mailing Address - Fax:
Practice Address - Street 1:5579 N TURRET WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-3230
Practice Address - Country:US
Practice Address - Phone:503-201-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202676103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical