Provider Demographics
NPI:1437392719
Name:BROOKS, SIMONE EVELYN
Entity Type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:EVELYN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 CARQUINEZ WAY
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:CA
Mailing Address - Zip Code:94525-1004
Mailing Address - Country:US
Mailing Address - Phone:510-410-8581
Mailing Address - Fax:
Practice Address - Street 1:1949 CARQUINEZ WAY
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:CA
Practice Address - Zip Code:94525-1004
Practice Address - Country:US
Practice Address - Phone:510-410-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43748106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist