Broom, Wilfred Carnell

Broom, Wilfred Carnell is an sole proprietor health care provider with primary practice located at 7171 Bowling Drive Suite 300 , Sacramento CA 95823. He recently has 3 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Other Service Providers / Peer Specialist, Behavioral Health & Social Service Providers / Counselor. Behavioral Health & Social Service Providers / Counselor is his primary health care specialty. Broom, Wilfred Carnell can be contacted via phone (916) 394-9195.

Contact Information

Primary practice address
7171 Bowling Drive Suite 300 Sacramento CA 95823
Phone: (916) 394-9195
Fax: (916) 392-2827
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Other Service Providers / Peer Specialist 175T00000X
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1750896288
LBN Legal business name Broom, Wilfred Carnell
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 6th, 2017
Last updated Jan 4th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750896288 NPPES
California MEDICAID 1508011065

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