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General NPI Number Information
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NPI Number | 1164621181
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Entity Type | Individual
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Provider Name | LAUREN EILEEN BROCH PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 255 LAFAYETTE AVE
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City | SUFFERN
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State | NY
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Zip | 10901-4812
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Country | US
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Telephone | 845-368-5517
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Fax |
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Provider Business Mailing Address
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Address Line | 21 MEADOWLARK RD
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City | RYE BROOK
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State | NY
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Zip | 10573-1209
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Country | US
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Telephone | 914-935-9838
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 011581
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License Number State | NY
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