Angela Christina Brock, LCSW, LMFT. MBA

Primary specialty

Social WorkerTaxonomy code 104100000X

License

3035 Issued in KY

Practice address

10300 Brookridge Village Blvd
Suite 104
Louisville, KY 40291

Phone

(502) 785-4322

Fax

(502) 785-4433

NPI assigned

May 1, 2007

Last updated

Dec 1, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brock Family Therapy Center Inc.Group PAC ID 7315253416, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brock Family Therapy Center Inc.

  • Adult Mental Health Clinic/Center
  • Louisville, KY
  • NPI 1609250992
  Medicare reassignment Care Compare group NPD Authorized official
• Wellspace Psychiatry LLC

  dba Wellspace Psychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Louisville, KY
  • NPI 1710694468
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1073734927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10300 BROOKRIDGE VILLAGE BLVD",
            "address_2": "SUITE 104",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40291",
            "telephone_number": "502-785-4322",
            "fax_number": "502-785-4433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10300 BROOKRIDGE VILLAGE BLVD",
            "address_2": "SUITE 104",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40291",
            "telephone_number": "502-785-4322",
            "fax_number": "502-785-4433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "ANGELA",
        "middle_name": "CHRISTINA",
        "name_prefix": "Mrs.",
        "credential": "LCSW, LMFT. MBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "KY",
            "license": "3035",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "KY",
            "license": "KY-0617",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100068240",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Lea Davis Broadwater, LMFT
• Broadway Dental PSC
• Broadway Eye Care Associates, PSC
• Brock Family Therapy Center Inc.
• Kayla Marie Brock-Provencher, CSW
• Charlotte Brock, COTA/L
• Courtney Lynn Brock, M.S., CCC-SLP
• Jamie Brock
• Jessica C Brock, PA-C
• Laura Rose Brock

• Social Worker in Louisville, KY
• Providers in Louisville, KY by specialty
• Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.