Provider Demographics
NPI:1710016589
Name:BROMIEL, ADELE SUSAN (MED)
Entity Type:Individual
Prefix:MRS
First Name:ADELE
Middle Name:SUSAN
Last Name:BROMIEL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6508
Mailing Address - Country:US
Mailing Address - Phone:520-529-2226
Mailing Address - Fax:520-577-5307
Practice Address - Street 1:2101 E RIVER RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6508
Practice Address - Country:US
Practice Address - Phone:520-529-2226
Practice Address - Fax:520-577-5307
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool