Jacqueline- Anne - Brock Armand, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW18075 Issued in FL

Practice address

24 Womurrung Avenue
Castle Hill, NSW 002154
AU

Phone

(813) 949-2933

NPI assigned

Jan 30, 2021

Last updated

Jan 30, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jacqueline Brock Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Structural Energetic Therapy Inc

  • Mental Health Counselor
  • Lutz, FL
  • NPI 1013148261
  NPD (past)
• Ultima Rehab-FL LLC

  • Geriatric Physical Therapist
  • North Fort Myers, FL
  • NPI 1053970194
  NPD (past)

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

{
    "created_epoch": "1611964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611964800000",
    "number": "1851982078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 WHITAKER RD STE B",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335495792"
        },
        {
            "country_code": "AU",
            "country_name": "Australia",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "24 WOMURRUNG AVENUE",
            "city": "CASTLE HILL",
            "state": "NSW",
            "postal_code": "002154",
            "telephone_number": "813-949-2933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARMAND",
        "first_name": "JACQUELINE-",
        "middle_name": "ANNE - BROCK",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-30",
        "last_updated": "2021-01-30",
        "certification_date": "2021-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW18075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "BROCK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.