Provider Demographics
NPI:1275218281
Name:BROOKS, JENNIFER EVE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EVE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 BONNIE BRAE CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7048
Mailing Address - Country:US
Mailing Address - Phone:732-619-4422
Mailing Address - Fax:
Practice Address - Street 1:5113 BONNIE BRAE CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-7048
Practice Address - Country:US
Practice Address - Phone:732-619-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD220701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical