Provider Demographics
NPI:1306126404
Name:BROCKBERG, DEBRA R (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:R
Last Name:BROCKBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:R
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:904 W 23RD ST; STE 101
Mailing Address - Street 2:HEARTLAND PSYCHOLOGICAL SERVICES
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-1206
Mailing Address - Country:US
Mailing Address - Phone:605-665-0841
Mailing Address - Fax:605-665-0096
Practice Address - Street 1:904 W 23RD ST; STE 101
Practice Address - Street 2:HEARTLAND PSYCHOLOGICAL SERVICES
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-1206
Practice Address - Country:US
Practice Address - Phone:605-665-0841
Practice Address - Fax:605-665-0096
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2943104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker