Provider Demographics
NPI:1578811063
Name:BROCHE, ANIBIS (MHC)
Entity Type:Individual
Prefix:
First Name:ANIBIS
Middle Name:
Last Name:BROCHE
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16464 SW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5735
Mailing Address - Country:US
Mailing Address - Phone:305-979-7309
Mailing Address - Fax:
Practice Address - Street 1:16464 SW 84TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5735
Practice Address - Country:US
Practice Address - Phone:305-979-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst