Provider Demographics
NPI:1407066012
Name:BROOKS, PAM F (LCSW)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:F
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4622 WOODLANDS VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2719
Mailing Address - Country:US
Mailing Address - Phone:407-296-8058
Mailing Address - Fax:407-292-8387
Practice Address - Street 1:2715 W FAIRBANKS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3327
Practice Address - Country:US
Practice Address - Phone:407-647-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSOW 48521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical