Provider Demographics
NPI:1437244134
Name:BROMLEY, MARK CALVIN (PHD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CALVIN
Last Name:BROMLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HEWITT RD
Mailing Address - Street 2:
Mailing Address - City:SPOFFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03462-4512
Mailing Address - Country:US
Mailing Address - Phone:603-363-8322
Mailing Address - Fax:
Practice Address - Street 1:17 93RD ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3748
Practice Address - Country:US
Practice Address - Phone:603-357-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH73106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist