Provider Demographics
NPI:1891033510
Name:STROM, DAVID (LISW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:STROM
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80
Mailing Address - Street 2:BOX 13593
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-9998
Mailing Address - Country:US
Mailing Address - Phone:315-634-0433
Mailing Address - Fax:
Practice Address - Street 1:18TH MEDICAL GROUP
Practice Address - Street 2:UNIT 5142 KADENA AB OKINAWA JAPAN
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96367-9998
Practice Address - Country:US
Practice Address - Phone:315-634-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical