Provider Demographics
NPI:1861680845
Name:BROM, AMY P (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:P
Last Name:BROM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:A
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 TARMAN DR
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-3932
Mailing Address - Country:US
Mailing Address - Phone:707-894-4229
Mailing Address - Fax:707-894-2954
Practice Address - Street 1:1600 WEEOT WAY
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4734
Practice Address - Country:US
Practice Address - Phone:707-825-5000
Practice Address - Fax:707-825-6747
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22123103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service