Provider Demographics
NPI:1326122029
Name:BROOKS-REILLY, RHODA C (LCSW)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:C
Last Name:BROOKS-REILLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33309 LILAC RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-3213
Mailing Address - Country:US
Mailing Address - Phone:760-805-4165
Mailing Address - Fax:760-742-1392
Practice Address - Street 1:33309 LILAC RD
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-3213
Practice Address - Country:US
Practice Address - Phone:760-805-4165
Practice Address - Fax:760-742-1392
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health