Provider Demographics
NPI:1265503593
Name:BROCKWAY, LINDA GAYLE (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:GAYLE
Last Name:BROCKWAY
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 PANAMA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6609
Mailing Address - Country:US
Mailing Address - Phone:215-732-2372
Mailing Address - Fax:
Practice Address - Street 1:4 E GERMANTOWN PIKE
Practice Address - Street 2:SUITE 204
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1533
Practice Address - Country:US
Practice Address - Phone:215-316-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW010951L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker