Provider Demographics
NPI:1295024511
Name:BROOKS, NANCY METRA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:METRA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 STONE ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1142
Mailing Address - Country:US
Mailing Address - Phone:978-630-4775
Mailing Address - Fax:
Practice Address - Street 1:116 STONE ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1142
Practice Address - Country:US
Practice Address - Phone:978-630-4775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical