MEDICARE: AHMY LYNN BROCK LMFT

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	000247-1	NY

General Provider Information

NPI Number	:	1063735124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMY LYNN BROCK LMFT

Provider Business Mailing Address
First Line	:	2997 SWEET RD
Second Line	:
City	:	JAMESVILLE
State	:	NY
Zip	:	13078-9697
Country	:	US
Telephone Number	:	315-416-7572
Fax Number	:	315-627-0273

Provider Business Practice Location Address
First Line	:	2997 SWEET RD
Second Line	:
City	:	JAMESVILLE
State	:	NY
Zip	:	13078-9697
Country	:	US
Telephone Number	:	315-416-7572
Fax Number	:	315-504-1046

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

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	06/07/2026

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