Provider Demographics
NPI:1447273818
Name:BROMBLE, SANDRA L (LCPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:BROMBLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 CHARTER OAK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4406
Mailing Address - Country:US
Mailing Address - Phone:410-435-8123
Mailing Address - Fax:
Practice Address - Street 1:7702 DUNMANWAY
Practice Address - Street 2:KEY POINT SERVICES, INC
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222
Practice Address - Country:US
Practice Address - Phone:410-282-1792
Practice Address - Fax:410-282-3195
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1558101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional