Provider Demographics
NPI:1437938016
Name:FROMBERG, CAREY THERESA
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:THERESA
Last Name:FROMBERG
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 1:322 APOPKA ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2729
Mailing Address - Country:US
Mailing Address - Phone:321-695-1094
Mailing Address - Fax:
Practice Address - Street 1:322 APOPKA ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2729
Practice Address - Country:US
Practice Address - Phone:321-695-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB997891106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician