Provider Demographics
NPI:1033703012
Name:BROOKS, ANDROMADA (MH16572)
Entity Type:Individual
Prefix:
First Name:ANDROMADA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MH16572
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 SHOMA DR STE 109
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4334
Mailing Address - Country:US
Mailing Address - Phone:561-291-8616
Mailing Address - Fax:
Practice Address - Street 1:2620 N AUSTRALIAN AVE STE 109
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5625
Practice Address - Country:US
Practice Address - Phone:561-291-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health