Provider Demographics
NPI:1528731460
Name:BROCK, MARY WARE (BCBA)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:WARE
Last Name:BROCK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:204 W TUSCALOOSA ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5428
Mailing Address - Country:US
Mailing Address - Phone:256-202-4885
Mailing Address - Fax:833-442-3336
Practice Address - Street 1:204 W TUSCALOOSA ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5428
Practice Address - Country:US
Practice Address - Phone:256-202-4885
Practice Address - Fax:833-442-3336
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL2021-059103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst