Provider Demographics
NPI:1093903486
Name:BROBERG, MATTHEW ALLEN (PLADC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALLEN
Last Name:BROBERG
Suffix:
Gender:M
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8822 WEBSTER PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144
Mailing Address - Country:US
Mailing Address - Phone:402-933-7082
Mailing Address - Fax:
Practice Address - Street 1:2101 S 42ND STREET
Practice Address - Street 2:HEARTLAND FAMILY SERVICE
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105
Practice Address - Country:US
Practice Address - Phone:402-553-3000
Practice Address - Fax:402-552-7444
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)