Provider Demographics
NPI:1699496059
Name:BROCKINGTON, ALLISON (LMSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BROCKINGTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5812 FARRAGUT RD APT 1E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1395
Mailing Address - Country:US
Mailing Address - Phone:718-964-7631
Mailing Address - Fax:
Practice Address - Street 1:5812 FARRAGUT RD APT 1E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-1395
Practice Address - Country:US
Practice Address - Phone:718-964-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11423401104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker