Provider Demographics
NPI:1639655152
Name:BOCKOVER, BRIELLE ASHLIE
Entity type:Individual
Prefix:
First Name:BRIELLE
Middle Name:ASHLIE
Last Name:BOCKOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 PIPER LN
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3122
Mailing Address - Country:US
Mailing Address - Phone:925-809-0128
Mailing Address - Fax:
Practice Address - Street 1:1210 CENTRAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2379
Practice Address - Country:US
Practice Address - Phone:925-809-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician