Provider Demographics
NPI:1982629531
Name:BROCKMAN, NANCY W (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:W
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:VA
Mailing Address - Zip Code:24574
Mailing Address - Country:US
Mailing Address - Phone:434-929-0355
Mailing Address - Fax:434-929-0357
Practice Address - Street 1:215 PANORAMA LN
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-4295
Practice Address - Country:US
Practice Address - Phone:434-929-0355
Practice Address - Fax:434-929-0357
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040039N81041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1096062OtherHIPPA
VA008915008Medicaid