Provider Demographics
NPI:1275185043
Name:BROSCH, CORY ANN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CORY
Middle Name:ANN
Last Name:BROSCH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 OBRIEN GLENWAY
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-9261
Mailing Address - Country:US
Mailing Address - Phone:315-591-6273
Mailing Address - Fax:
Practice Address - Street 1:12 AMITY ST
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1350
Practice Address - Country:US
Practice Address - Phone:585-542-8897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health