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General NPI Number Information
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NPI Number | 1689479602
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Entity Type | Individual
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Provider Name | BROCK D'ALESSANDRI CSW
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Gender | Male
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 106 KEENE SOUTH ELKHORN RD
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City | KEENE
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State | KY
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Zip | 40339-9998
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Country | US
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Telephone | 502-517-9418
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19
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City | NICHOLASVILLE
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State | KY
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Zip | 40340-0019
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Country | US
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Telephone | 502-517-9418
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 255316
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 260286
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License Number State | KY
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