Healthcare Provider Details

I. General information

NPI: 1982629531
Provider Name (Legal Business Name): NANCY W BROCKMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PANORAMA LN
AMHERST VA
24521-4295
US

IV. Provider business mailing address

PO BOX 128
MONROE VA
24574
US

V. Phone/Fax

Practice location:
  • Phone: 434-929-0355
  • Fax: 434-929-0357
Mailing address:
  • Phone: 434-929-0355
  • Fax: 434-929-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09040039N8
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: