Provider Demographics
NPI:1033731518
Name:WILLIAMS BROOKS, JACQUELYN RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:RENEE
Last Name:WILLIAMS BROOKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:RENEE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41045 RIVEROCK LN
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1833
Mailing Address - Country:US
Mailing Address - Phone:661-916-4549
Mailing Address - Fax:
Practice Address - Street 1:44709 DATE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3101
Practice Address - Country:US
Practice Address - Phone:661-916-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA809351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical