Provider Demographics
NPI:1568416071
Name:BROMBERG, D. RICHARD (PHD)
Entity Type:Individual
Prefix:
First Name:D.
Middle Name:RICHARD
Last Name:BROMBERG
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 1:7345 FAR HILLS AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4415
Mailing Address - Country:US
Mailing Address - Phone:937-439-1224
Mailing Address - Fax:937-433-0726
Practice Address - Street 1:7345 FAR HILLS AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4415
Practice Address - Country:US
Practice Address - Phone:937-439-1224
Practice Address - Fax:937-433-0726
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical