Provider Demographics
NPI:1407865405
Name:COOK, BROOKS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BROOKS
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:SUE
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:324 SUEY RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-3402
Mailing Address - Country:US
Mailing Address - Phone:805-268-0430
Mailing Address - Fax:
Practice Address - Street 1:324 SUEY RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-3402
Practice Address - Country:US
Practice Address - Phone:805-332-3269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA913271041C0700X
NYR0467701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN62855-1Medicare ID - Type Unspecified