Provider Demographics
NPI:1376218743
Name:BROOKE, TIFFANI LYNN
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:LYNN
Last Name:BROOKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 BIG WOODS RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-3535
Mailing Address - Country:US
Mailing Address - Phone:302-670-7927
Mailing Address - Fax:
Practice Address - Street 1:1310 BRIDGEVILLE HWY
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-1617
Practice Address - Country:US
Practice Address - Phone:302-394-6051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health