Provider Demographics
NPI:1871636233
Name:CROOM, NORMAN
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:CROOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 E HOLT BLVD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-2107
Mailing Address - Country:US
Mailing Address - Phone:909-933-6341
Mailing Address - Fax:909-933-6355
Practice Address - Street 1:1647 HOLT BLVD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2107
Practice Address - Country:US
Practice Address - Phone:909-933-6341
Practice Address - Fax:909-933-6355
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00339101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)