Provider Demographics
NPI:1578334512
Name:BROEMS, VICTORIA
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:BROEMS
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 1:35 BLUEBERRY CMNS
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2642
Mailing Address - Country:US
Mailing Address - Phone:516-761-5236
Mailing Address - Fax:
Practice Address - Street 1:1955 MERRICK RD STE 204
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4635
Practice Address - Country:US
Practice Address - Phone:516-761-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026277103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist