Provider Demographics
NPI:1477829273
Name:WALKER, BROOKE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WALKER
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 1:237 W 105TH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3900
Mailing Address - Country:US
Mailing Address - Phone:217-306-5834
Mailing Address - Fax:
Practice Address - Street 1:237 W 105TH ST
Practice Address - Street 2:APT 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3900
Practice Address - Country:US
Practice Address - Phone:217-306-5834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst