Provider Demographics
NPI:1003142415
Name:BROOKS, SARINA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:SARINA
Middle Name:LYNN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITNEYVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04654-4230
Mailing Address - Country:US
Mailing Address - Phone:207-255-9025
Mailing Address - Fax:
Practice Address - Street 1:10 BARKER ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1404
Practice Address - Country:US
Practice Address - Phone:207-454-2745
Practice Address - Fax:207-454-7387
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC11534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432911799Medicaid