Provider Demographics
NPI:1164620514
Name:BROOKS, REBECCA S (LICSW, MSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 OAK KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-2060
Mailing Address - Country:US
Mailing Address - Phone:802-879-6242
Mailing Address - Fax:
Practice Address - Street 1:187 ST PAUL ST
Practice Address - Street 2:NETWORKS INC
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-863-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900011801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical