Healthcare Provider Details

I. General information

NPI: 1922162478
Provider Name (Legal Business Name): DAWN MARIE BROCK PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 MDG/SGOW UNIT 7095 BOX 185
APO AE
09824-5185
US

IV. Provider business mailing address

39 MDG/SGOW UNIT 7095 BOX 185
APO AE
09824-5185
US

V. Phone/Fax

Practice location:
  • Phone: 0113223166452
  • Fax: 0113223163160
Mailing address:
  • Phone: 0113223166452
  • Fax: 0113223163160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: