Provider Demographics
NPI:1346969771
Name:BROOKS, LAWRENCE BERNARD JR (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:BERNARD
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 WHITE OAK RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-7429
Mailing Address - Country:US
Mailing Address - Phone:302-535-7682
Mailing Address - Fax:
Practice Address - Street 1:725 HORSEPOND RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7232
Practice Address - Country:US
Practice Address - Phone:302-747-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010328363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health