Provider Demographics
NPI:1083196240
Name:AGUIAR, BROOKE CARISSA
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:CARISSA
Last Name:AGUIAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3596
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94064-3596
Mailing Address - Country:US
Mailing Address - Phone:303-519-1469
Mailing Address - Fax:
Practice Address - Street 1:530 EL CAMINO REAL APT 110
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-5173
Practice Address - Country:US
Practice Address - Phone:303-519-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5026101YM0800X
CA13260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health