Provider Demographics
NPI:1437186103
Name:BROOKS, FRANKLIN L JR (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:L
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MELLEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2109
Mailing Address - Country:US
Mailing Address - Phone:207-780-6068
Mailing Address - Fax:
Practice Address - Street 1:15 MELLEN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2109
Practice Address - Country:US
Practice Address - Phone:207-780-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC16221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7175Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBERF