Provider Demographics
NPI:1275666950
Name:MCBROOM, ELIZABETH BEA
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BEA
Last Name:MCBROOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 D ST
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-2463
Mailing Address - Country:US
Mailing Address - Phone:760-788-9724
Mailing Address - Fax:760-788-9754
Practice Address - Street 1:1330 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-3019
Practice Address - Country:US
Practice Address - Phone:760-788-9724
Practice Address - Fax:760-788-9754
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health