Provider Demographics
NPI:1154538783
Name:BOCKMAN, PHILIP (LCSW ACSW)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:BOCKMAN
Suffix:
Gender:M
Credentials:LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 GREEN ST
Mailing Address - Street 2:APT C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130
Mailing Address - Country:US
Mailing Address - Phone:917-868-7405
Mailing Address - Fax:
Practice Address - Street 1:817 BROADWAY
Practice Address - Street 2:9TH FL., ROOM 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:917-868-7405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0505141103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy