Provider Demographics
NPI:1386659704
Name:BROOKS, SUSAN WHITMORE (MSSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WHITMORE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6064
Mailing Address - Country:US
Mailing Address - Phone:608-692-6066
Mailing Address - Fax:608-275-5546
Practice Address - Street 1:2024 NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6064
Practice Address - Country:US
Practice Address - Phone:608-692-6066
Practice Address - Fax:608-275-5546
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14581231041C0700X
NCC006398104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39581400Medicaid
002174050Medicare ID - Type Unspecified
WI00074050Medicare PIN