Provider Demographics
NPI:1689218612
Name:BROFMAN, KYLIE (RBT)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:BROFMAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 FITZWATERTOWN RD STE A2
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1928
Mailing Address - Country:US
Mailing Address - Phone:877-933-9932
Mailing Address - Fax:
Practice Address - Street 1:630 FITZWATERTOWN RD STE A2
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1928
Practice Address - Country:US
Practice Address - Phone:877-933-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-02
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-12446106E00000X
PARBT-19-99177106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician