Provider Demographics
NPI:1366648370
Name:BROOKS, JEANNIE SHAYNA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:SHAYNA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 HOMEWOOD BLVD
Mailing Address - Street 2:#217
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6918
Mailing Address - Country:US
Mailing Address - Phone:954-854-6145
Mailing Address - Fax:
Practice Address - Street 1:1850 HOMEWOOD BLVD APT 217
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6894
Practice Address - Country:US
Practice Address - Phone:954-854-6145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017781103T00000X, 282N00000X
FL7961103TC0700X, 103TF0200X, 103TB0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No282N00000XHospitalsGeneral Acute Care Hospital
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent