| Doctor Name: | MARY BROCCOLI |
| NPI Number: | 1154306983 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 21113 |
| Business Practice Address: | Naval Hospital, Camp Pendleton Attention: Code 094 Camp Pendleton, CA - 920555191 |
| Business Phone Number: | 7607251555 |
| Business Fax Number: | 7607251350 |
| Mailing Address: | Po Box 555191, Attention: Code 094 Bldg H100 CAMP PENDLETON |
| State: | CA |
| Postal Code: | 920555191 |
| Phone Number: | 7607251555 |
| Fax Number: | 7607251350 |
| NPI Enumeration Date: | 12/14/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 21113 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |