Individual
GLENN BOMBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
100 HOSPITALITY DRIVE, BERLIN, VT 05641
(802) 223-4156
(802) 223-4332
Mailing address
PO BOX G, RANDOLPH, VT 05060-0167
(802) 728-4466
(802) 728-4197
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
151.0124410
VT
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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