1851982078 NPI number — JACQUELINE- ANNE - BROCK ARMAND LCSW

Table of content: JACQUELINE- ANNE - BROCK ARMAND LCSW (NPI 1851982078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851982078 NPI number — JACQUELINE- ANNE - BROCK ARMAND LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARMAND
Provider First Name:
JACQUELINE-
Provider Middle Name:
ANNE - BROCK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROCK
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851982078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
156 WHITAKER RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUTZ
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33549-5792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 WOMURRUNG AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLE HILL
Provider Business Practice Location Address State Name:
NSW
Provider Business Practice Location Address Postal Code:
002154
Provider Business Practice Location Address Country Code:
AU
Provider Business Practice Location Address Telephone Number:
813-949-2933
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW18075 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com