MEDICARE: DR. MARY WARE BROCK BCBA

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	103K00000X	Behavior Analyst	2021-059	AL

General Provider Information

NPI Number	:	1528731460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY WARE BROCK BCBA

Provider Business Mailing Address
First Line	:	2460 MALL RD
Second Line	:
City	:	FLORENCE
State	:	AL
Zip	:	35630-2869
Country	:	US
Telephone Number	:	256-202-4885
Fax Number	:	833-442-3336

Provider Business Practice Location Address
First Line	:	2460 MALL RD
Second Line	:
City	:	FLORENCE
State	:	AL
Zip	:	35630-2869
Country	:	US
Telephone Number	:	256-202-4885
Fax Number	:	833-442-3336

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

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	12/05/2025

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Directions to “ DR. MARY WARE BROCK BCBA” Practice Location

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