Healthcare Provider Details

I. General information

NPI: 1306281365
Provider Name (Legal Business Name): BROCKTON DAVID HILL J.D,M.A.,MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2013
Last Update Date: 05/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S EUCLID AVE SUITE 6
PASADENA CA
91101-2446
US

IV. Provider business mailing address

130 S EUCLID AVE SUITE 6
PASADENA CA
91101-2446
US

V. Phone/Fax

Practice location:
  • Phone: 818-726-1459
  • Fax:
Mailing address:
  • Phone: 818-726-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberMFT37755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: