Provider Demographics
NPI:1124577721
Name:BROOMFIELD, ROSALIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:BROOMFIELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:MACKE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1590 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1967
Mailing Address - Country:US
Mailing Address - Phone:541-346-2154
Mailing Address - Fax:
Practice Address - Street 1:211 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2773
Practice Address - Country:US
Practice Address - Phone:541-915-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-25
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
ORL102981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL10298OtherBLSW