Provider Demographics
NPI:1881367704
Name:MCBROOM, SIING SOPHI (LCSW, LISW, MSW)
Entity type:Individual
Prefix:
First Name:SIING
Middle Name:SOPHI
Last Name:MCBROOM
Suffix:
Gender:F
Credentials:LCSW, LISW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2783 MARTIN RD # 137
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2096
Mailing Address - Country:US
Mailing Address - Phone:831-419-6700
Mailing Address - Fax:
Practice Address - Street 1:7846 TIPPERARY CT S
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-8510
Practice Address - Country:US
Practice Address - Phone:831-419-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLICSW49651041C0700X
NHLICSW49651041C0700X
OHLISW123049721041C0700X
CALCSW1126511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical