1952469744 NPI number — DOROTHY MARIE BROCCO MSW,LCSW,CBT,BCD

Table of content: DOROTHY MARIE BROCCO MSW,LCSW,CBT,BCD (NPI 1952469744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952469744 NPI number — DOROTHY MARIE BROCCO MSW,LCSW,CBT,BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROCCO
Provider First Name:
DOROTHY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW,LCSW,CBT,BCD
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1952469744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 CHERRYWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL SPRINGS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08021-5605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-566-0248
Provider Business Mailing Address Fax Number:
856-566-0248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 LIBERTY PLACE, STE. 2
Provider Second Line Business Practice Location Address:
LAKEVIEW BUSINESS PARK
Provider Business Practice Location Address City Name:
SICKLERVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-979-9060
Provider Business Practice Location Address Fax Number:
856-302-3068
Provider Enumeration Date:
12/05/2006

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:  44SC00162600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 398500 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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