Provider Demographics
NPI:1386020279
Name:BROOKS, STANTON
Entity Type:Individual
Prefix:
First Name:STANTON
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14545J S MILITARY TRL # 139
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-3730
Mailing Address - Country:US
Mailing Address - Phone:425-241-1450
Mailing Address - Fax:
Practice Address - Street 1:1300 NW 17TH AVE
Practice Address - Street 2:UNIT 273A
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2578
Practice Address - Country:US
Practice Address - Phone:844-239-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator