Provider Demographics
NPI:1528548609
Name:BROMBERG, ROBIN (LICSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BROMBERG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 PRESTON ST APT 7A
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2564
Mailing Address - Country:US
Mailing Address - Phone:781-718-4815
Mailing Address - Fax:
Practice Address - Street 1:30 WALLINGFORD RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-4708
Practice Address - Country:US
Practice Address - Phone:617-912-8487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10254021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical