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General NPI Number Information
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NPI Number | 1952469744
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Entity Type | Individual
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Provider Name | DOROTHY MARIE BROCCO MSW,LCSW,CBT,BCD
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 1600 LIBERTY PLACE, STE. 2 LAKEVIEW BUSINESS PARK
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City | SICKLERVILLE
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State | NJ
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Zip | 08081
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Country | US
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Telephone | 856-979-9060
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Fax | 856-302-3068
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Provider Business Mailing Address
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Address Line | 217 CHERRYWOOD DR
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City | LAUREL SPRINGS
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State | NJ
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Zip | 08021-5605
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Country | US
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Telephone | 856-566-0248
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Fax | 856-566-0248
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC00162600
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License Number State | NJ
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