Provider Demographics
NPI:1477627859
Name:BROOKS, JOEL SIDNEY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:SIDNEY
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6237 EAGLEBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-1518
Mailing Address - Country:US
Mailing Address - Phone:813-978-3960
Mailing Address - Fax:813-978-0475
Practice Address - Street 1:3500 E FLETCHER AVE
Practice Address - Street 2:SUITE 129
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4708
Practice Address - Country:US
Practice Address - Phone:813-978-3960
Practice Address - Fax:813-978-0475
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 17611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical