Provider Demographics
NPI:1881802155
Name:BROCKMAN, WILLIAM GARLINGTON (DMIN)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GARLINGTON
Last Name:BROCKMAN
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 NW 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3463
Mailing Address - Country:US
Mailing Address - Phone:561-395-4402
Mailing Address - Fax:
Practice Address - Street 1:698 NW 11TH AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3463
Practice Address - Country:US
Practice Address - Phone:561-395-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT334106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist