Provider Demographics
NPI:1235268988
Name:BROOKS, PATRICIA ANNE (PHD LCSW)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANNE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15205 SONOMA HWY
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLEN
Mailing Address - State:CA
Mailing Address - Zip Code:95442-9455
Mailing Address - Country:US
Mailing Address - Phone:707-337-7524
Mailing Address - Fax:707-935-5153
Practice Address - Street 1:347 ANDRIEUX ST
Practice Address - Street 2:INTEGRATIVE MEDICINE
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6811
Practice Address - Country:US
Practice Address - Phone:707-935-5137
Practice Address - Fax:707-935-5153
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS22148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01690ZOtherPPIN
CAS33979Medicare UPIN