Provider Demographics
NPI:1538139191
Name:BROMLEY, SUSAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:BROMLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 37TH AVENUE CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2565
Mailing Address - Country:US
Mailing Address - Phone:970-352-6830
Mailing Address - Fax:970-352-1945
Practice Address - Street 1:1015 37TH AVENUE CT
Practice Address - Street 2:SUITE 102
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2565
Practice Address - Country:US
Practice Address - Phone:970-352-8630
Practice Address - Fax:970-352-1945
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1086103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA354-6Medicare ID - Type Unspecified