Provider Demographics
NPI:1083293385
Name:BROOKS, RICHARD (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14837 RICE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-4648
Mailing Address - Country:US
Mailing Address - Phone:507-461-0967
Mailing Address - Fax:
Practice Address - Street 1:125 LANDMARK DR NE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-1628
Practice Address - Country:US
Practice Address - Phone:507-461-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27401104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker