Provider Demographics
NPI:1255446753
Name:BRONAUGH, TORI (PHD)
Entity type:Individual
Prefix:DR
First Name:TORI
Middle Name:
Last Name:BRONAUGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 CLOVER HILL CT
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5763
Mailing Address - Country:US
Mailing Address - Phone:215-499-5872
Mailing Address - Fax:
Practice Address - Street 1:1430 BROADWAY STE 1430
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3308
Practice Address - Country:US
Practice Address - Phone:347-201-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00337200103TC0700X, 103TC1900X
NY010162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling