Provider Demographics
NPI:1609214741
Name:BROOMALL, WILLAIM ROBERT (MASTERS DEGREE)
Entity Type:Individual
Prefix:
First Name:WILLAIM
Middle Name:ROBERT
Last Name:BROOMALL
Suffix:
Gender:M
Credentials:MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 W MINER ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2834
Mailing Address - Country:US
Mailing Address - Phone:610-429-0594
Mailing Address - Fax:
Practice Address - Street 1:479 THOMAS JONES WAY
Practice Address - Street 2:SUITE 800
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2580
Practice Address - Country:US
Practice Address - Phone:484-565-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor