Provider Demographics
NPI:1417213174
Name:BROOKS, JAMAAL CLIFTON
Entity Type:Individual
Prefix:MR
First Name:JAMAAL
Middle Name:CLIFTON
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 1:167 KENNEDY DR
Mailing Address - Street 2:704
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3467
Mailing Address - Country:US
Mailing Address - Phone:857-222-9744
Mailing Address - Fax:
Practice Address - Street 1:167 KENNEDY DR
Practice Address - Street 2:704
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3467
Practice Address - Country:US
Practice Address - Phone:857-222-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator