Provider Demographics
NPI:1558732214
Name:BROCK, TRICIA MARIE (MFA, LP)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:MARIE
Last Name:BROCK
Suffix:
Gender:F
Credentials:MFA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W 10TH ST APT 6B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8705
Mailing Address - Country:US
Mailing Address - Phone:347-804-8807
Mailing Address - Fax:
Practice Address - Street 1:60 W 10TH ST APT 6B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8705
Practice Address - Country:US
Practice Address - Phone:347-804-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001045102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst