Provider Demographics
NPI:1629337969
Name:BROSCH, REBECCA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:BROSCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 HERITAGE VILLAGE PLZ
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3053
Mailing Address - Country:US
Mailing Address - Phone:703-754-0636
Mailing Address - Fax:703-754-0646
Practice Address - Street 1:7230 HERITAGE VILLAGE PLZ
Practice Address - Street 2:SUITE 202
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3053
Practice Address - Country:US
Practice Address - Phone:703-754-0636
Practice Address - Fax:703-754-0646
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004574103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical