Provider Demographics
NPI:1194205815
Name:FIORI, BROOKE ROSE (PPS)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ROSE
Last Name:FIORI
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8343 PALMERSON DR
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-5195
Mailing Address - Country:US
Mailing Address - Phone:916-770-8816
Mailing Address - Fax:
Practice Address - Street 1:8343 PALMERSON DR
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-5195
Practice Address - Country:US
Practice Address - Phone:916-770-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool