Provider Demographics
NPI:1083183032
Name:DEMBERT, BROOKE DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:DIANE
Last Name:DEMBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:DIANE
Other - Last Name:POSTLEWAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4110 CHAIN BRIDGE RD STE 214
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4020
Mailing Address - Country:US
Mailing Address - Phone:703-246-2592
Mailing Address - Fax:
Practice Address - Street 1:4110 CHAIN BRIDGE RD STE 214
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4020
Practice Address - Country:US
Practice Address - Phone:703-246-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040090671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical