Provider Demographics
NPI:1407049968
Name:BROMBEREK, STEPHEN PHILLIP
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PHILLIP
Last Name:BROMBEREK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NNMC 8901 ROCKVILLE PIKE
Mailing Address - Street 2:BUILDING 7, ROOM 6303
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:301-319-8314
Mailing Address - Fax:
Practice Address - Street 1:NNMC 8901 ROCKVILLE PIKE
Practice Address - Street 2:BUILDING 7, ROOM 6303
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-319-8314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-19
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003374A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34003374AOtherINDIANA HEALTH PROFESSION