Provider Demographics
NPI:1356479125
Name:BROTMAN, RICHARD DENNIS (MFT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DENNIS
Last Name:BROTMAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80158
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91118-8158
Mailing Address - Country:US
Mailing Address - Phone:626-577-9728
Mailing Address - Fax:626-332-6587
Practice Address - Street 1:230 N MARYLAND
Practice Address - Street 2:SUITE 303
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206
Practice Address - Country:US
Practice Address - Phone:626-577-9728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist