Provider Demographics
NPI:1053435446
Name:BROCKNER, AUDREY JACOBS (MSW, LCSW, BCD)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:JACOBS
Last Name:BROCKNER
Suffix:
Gender:F
Credentials:MSW, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BEECHMONT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-4613
Mailing Address - Country:US
Mailing Address - Phone:914-235-5646
Mailing Address - Fax:914-235-7852
Practice Address - Street 1:420 BEECHMONT DR
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-4613
Practice Address - Country:US
Practice Address - Phone:914-235-5646
Practice Address - Fax:914-235-7852
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR031433-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical