Provider Demographics
NPI:1255741237
Name:BOMBERG, ANN (LCSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BOMBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11829 RIDGE PKWY
Mailing Address - Street 2:632
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5079
Mailing Address - Country:US
Mailing Address - Phone:720-442-4506
Mailing Address - Fax:
Practice Address - Street 1:9351 GRANT ST
Practice Address - Street 2:480
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4358
Practice Address - Country:US
Practice Address - Phone:720-442-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-9930431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61583014Medicaid
CO351691YMT5Medicare PIN