MEDICARE: MS. SHEILA COX VAN DEN BROECK LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1205982923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHEILA COX VAN DEN BROECK LCSW

Provider Business Mailing Address
First Line	:	PO BOX 351
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-7023
Country	:	US
Telephone Number	:	860-262-5358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 SILVER STREET
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-7023
Country	:	US
Telephone Number	:	860-262-5358
Fax Number	:

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	01/04/2017

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