Provider Demographics
NPI:1730396516
Name:BROCK, JUDITH (CNM)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 COACHING LN
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05037-4400
Mailing Address - Country:US
Mailing Address - Phone:802-484-5187
Mailing Address - Fax:
Practice Address - Street 1:30 LOCUST ST.
Practice Address - Street 2:COOLEY DICKINSON CENTER FOR MIDWIFERY CARE
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01061
Practice Address - Country:US
Practice Address - Phone:413-584-8953
Practice Address - Fax:413-584-1093
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154535367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife