MEDICARE: MRS. MONIKA SILVIA BROECKER MS, MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	70291	CA

General Provider Information

NPI Number	:	1053669317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONIKA SILVIA BROECKER MS, MA

Provider Business Mailing Address
First Line	:	2210 CALIFORNIA ST # B
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-1608
Country	:	US
Telephone Number	:	650-296-3942
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 CALIFORNIA ST # B
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-1608
Country	:	US
Telephone Number	:	650-296-3942
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	06/27/2013

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