Provider Demographics
NPI:1083649891
Name:BROOKS, LARRY (LCSW)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 SKOKIE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4013
Mailing Address - Country:US
Mailing Address - Phone:847-362-4977
Mailing Address - Fax:
Practice Address - Street 1:910 SKOKIE BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4013
Practice Address - Country:US
Practice Address - Phone:847-362-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0002341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical