Provider Demographics
NPI:1083736052
Name:BROOKS, GLENWOOD C JR (PHD)
Entity Type:Individual
Prefix:
First Name:GLENWOOD
Middle Name:C
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 TILGHMAN RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1921
Mailing Address - Country:US
Mailing Address - Phone:410-546-4600
Mailing Address - Fax:410-546-8388
Practice Address - Street 1:220 TILGHMAN RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1921
Practice Address - Country:US
Practice Address - Phone:410-546-4600
Practice Address - Fax:410-546-8388
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1317103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG078Medicare ID - Type Unspecified