Individual
LORI BROCKWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
138 NORTH COURT STREET, WAMPSVILLE, NY 13163-0605
(315) 366-2839
Mailing address
PO BOX 605, WAMPSVILLE, NY 13163-0605
(315) 366-2361
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/13/2012
Last updated
06/13/2012
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