Provider Demographics
NPI:1346850898
Name:MAHONEY BROOKS, CHRISTINE L (CLC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:MAHONEY BROOKS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 MIDWOOD ST APT D8
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1159
Mailing Address - Country:US
Mailing Address - Phone:347-806-6736
Mailing Address - Fax:
Practice Address - Street 1:546 MIDWOOD ST APT D8
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1159
Practice Address - Country:US
Practice Address - Phone:347-806-6736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYALPP-257572174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty