Provider Demographics
NPI:1225054380
Name:BROCKMAN, HILDEGARD D (MSW)
Entity Type:Individual
Prefix:
First Name:HILDEGARD
Middle Name:D
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12505 ORANGE DR
Mailing Address - Street 2:SUITE 903
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4300
Mailing Address - Country:US
Mailing Address - Phone:954-236-6621
Mailing Address - Fax:954-438-4025
Practice Address - Street 1:12505 ORANGE DR
Practice Address - Street 2:SUITE 903
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4300
Practice Address - Country:US
Practice Address - Phone:954-236-6621
Practice Address - Fax:954-438-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 20501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2445Medicare ID - Type Unspecified