Provider Demographics
NPI:1548483175
Name:BROCH, MORTON H (PHD)
Entity type:Individual
Prefix:DR
First Name:MORTON
Middle Name:H
Last Name:BROCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DEPOT ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-1856
Mailing Address - Country:US
Mailing Address - Phone:413-743-9244
Mailing Address - Fax:413-743-9244
Practice Address - Street 1:19 DEPOT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-1856
Practice Address - Country:US
Practice Address - Phone:413-743-9244
Practice Address - Fax:413-743-9244
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist