Individual
MS. ELISE BROMBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
329 W MOUNT AIRY AVE, PHILADELPHIA, PA 19119-2941
(215) 247-6186
Mailing address
329 W MOUNT AIRY AVE, PHILADELPHIA, PA 19119-2941
(215) 247-6186
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW012775
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
543509
MAGELLAN
PA
01
—
CW012775
LCSW
PA
Enumeration date
06/10/2007
Last updated
07/08/2007
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