Provider Demographics
NPI:1902250806
Name:CATHERINE BROCCOLI, LMFT
Entity Type:Organization
Organization Name:CATHERINE BROCCOLI, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCCOLI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:914-589-7435
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-0734
Mailing Address - Country:US
Mailing Address - Phone:914-589-7435
Mailing Address - Fax:
Practice Address - Street 1:13 KILLIAN LN
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-2851
Practice Address - Country:US
Practice Address - Phone:914-589-7435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-17
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000854-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health