Provider Demographics
NPI:1326302555
Name:SOVOCOOL, BROOKE ANDERSON (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ANDERSON
Last Name:SOVOCOOL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:NICOLE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:12 GOLDEN HILL AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3041
Mailing Address - Country:US
Mailing Address - Phone:508-494-5004
Mailing Address - Fax:
Practice Address - Street 1:20 IRVING ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2467
Practice Address - Country:US
Practice Address - Phone:508-799-3020
Practice Address - Fax:508-799-8280
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5070871041S0200X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist