Provider Demographics
NPI:1881063832
Name:BROERSMA, CAROL (MSW, LCSW INTERN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BROERSMA
Suffix:
Gender:F
Credentials:MSW, LCSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 US HIGHWAY 395 N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5265
Mailing Address - Country:US
Mailing Address - Phone:775-782-3671
Mailing Address - Fax:
Practice Address - Street 1:1528 US HIGHWAY 395 N
Practice Address - Street 2:SUITE 100
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5265
Practice Address - Country:US
Practice Address - Phone:775-782-3671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6234-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical