Provider Demographics
NPI:1235681339
Name:SMITH, BROOKE KATHLEEN (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:KATHLEEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4138 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:HOLMES
Mailing Address - State:NY
Mailing Address - Zip Code:12531-5109
Mailing Address - Country:US
Mailing Address - Phone:845-519-4111
Mailing Address - Fax:
Practice Address - Street 1:15 FORTUNE ROAD
Practice Address - Street 2:
Practice Address - City:WEST MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941
Practice Address - Country:US
Practice Address - Phone:845-692-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097180101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional