Provider Demographics
NPI:1154461226
Name:BROM, JOHN LOWELL (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LOWELL
Last Name:BROM
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 GEORGETOWN CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-6719
Mailing Address - Country:US
Mailing Address - Phone:630-664-3941
Mailing Address - Fax:
Practice Address - Street 1:4300 COMMERCE CT STE 310
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3698
Practice Address - Country:US
Practice Address - Phone:630-544-3324
Practice Address - Fax:630-544-3325
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical