| Doctor Name: | PROF. TERESA ANTONIA BROCCOLI |
| NPI Number: | 1225368665 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, L.C.S.W. |
| License Number: | LCSW 23968 |
| Business Practice Address: | 4300 Soquel Dr Spc 200 Soquel, CA - 950732150 |
| Business Phone Number: | 8315664409 |
| Business Fax Number: | 8314622561 |
| Mailing Address: | 5105 Soquel Dr., Suite 200 SOQUEL |
| State: | CA |
| Postal Code: | 950730000 |
| Phone Number: | 8315664409 |
| Fax Number: | 8314622561 |
| NPI Enumeration Date: | 01/07/2010 |
| NPI Last Update Date: | 05/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCSW 23968 |
| 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 |