Provider Demographics
NPI:1952469744
Name:BROCCO, DOROTHY MARIE (MSW,LCSW,CBT,BCD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MARIE
Last Name:BROCCO
Suffix:
Gender:F
Credentials:MSW,LCSW,CBT,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-5605
Mailing Address - Country:US
Mailing Address - Phone:856-566-0248
Mailing Address - Fax:856-566-0248
Practice Address - Street 1:1600 LIBERTY PLACE, STE. 2
Practice Address - Street 2:LAKEVIEW BUSINESS PARK
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081
Practice Address - Country:US
Practice Address - Phone:856-979-9060
Practice Address - Fax:856-302-3068
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001626001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ398500OtherVALUE OPTIONS