Individual
EUGENIA M BROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
70 PINE ST, PINE ST SCHOOL BASED, WATERBURY, CT 06710-2169
(203) 756-7287
(203) 596-0722
Mailing address
141 E MAIN ST, 4TH FLOOR ADMINISTRATION, WATERBURY, CT 06702-2310
(203) 574-9000
(203) 574-9006
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
637
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004039202
—
CT
01
—
12659263
CAQH
—
Enumeration date
06/25/2013
Last updated
04/02/2014
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