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General NPI Number Information
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NPI Number | 1063735124
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Entity Type | Individual
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Provider Name | AHMY LYNN BROCK LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 5900 N BURDICK ST STE 201
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9463
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Country | US
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Telephone | 315-416-7572
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Fax | 315-627-0273
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Provider Business Mailing Address
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Address Line | 2997 SWEET RD
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City | JAMESVILLE
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State | NY
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Zip | 13078-9697
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Country | US
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Telephone | 315-416-7572
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Fax | 315-627-0273
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000247-1
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License Number State | NY
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