Healthcare Provider Details

I. General information

NPI: 1558280354
Provider Name (Legal Business Name): ANDREA BROCKMANN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PARK AVE FL 2
SAINT LOUIS MO
63110-2514
US

IV. Provider business mailing address

3800 PARK AVE FL 2
SAINT LOUIS MO
63110-2514
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5667
  • Fax: 314-268-2784
Mailing address:
  • Phone: 314-577-5667
  • Fax: 314-268-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2025053580
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: