Provider Demographics
NPI:1386657740
Name:BROOKS, ALICE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISSIE
Other - Middle Name:
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:31 ASHFORD DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4552
Mailing Address - Country:US
Mailing Address - Phone:860-205-1829
Mailing Address - Fax:
Practice Address - Street 1:31 ASHFORD DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4552
Practice Address - Country:US
Practice Address - Phone:860-205-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0028901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT079524OtherMHN PROVIDER NUMBER
CT140002890 CT01OtherBLUE CROSS PROVIDER
CTP3203033OtherOXFORD PROVIDER NUMBER