Provider Demographics
NPI:1992214365
Name:BROMMER, ALEXANDRA PAIGE
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:PAIGE
Last Name:BROMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 OLD YORK RD STE 301
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-4626
Mailing Address - Country:US
Mailing Address - Phone:215-395-8266
Mailing Address - Fax:215-754-0989
Practice Address - Street 1:1021 OLD YORK RD STE 301
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-4626
Practice Address - Country:US
Practice Address - Phone:215-395-8266
Practice Address - Fax:215-754-0989
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty