Provider Demographics
NPI:1972239549
Name:SENIOR-BROMFIELD, STACY (MSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SENIOR-BROMFIELD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6341 SW 35TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5069
Mailing Address - Country:US
Mailing Address - Phone:954-997-7212
Mailing Address - Fax:
Practice Address - Street 1:2601 E OAKLAND PARK BLVD STE 205
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1658
Practice Address - Country:US
Practice Address - Phone:954-997-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical