Provider Demographics
NPI:1518140714
Name:BROOKS, LISA RENEE' (LGSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE'
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:RENEE'
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LGSW
Mailing Address - Street 1:10 N GREENE ST
Mailing Address - Street 2:RM 1D-159A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1524
Mailing Address - Country:US
Mailing Address - Phone:410-605-7263
Mailing Address - Fax:410-605-7933
Practice Address - Street 1:10 N GREENE ST
Practice Address - Street 2:RM 1D-159A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7263
Practice Address - Fax:410-605-7933
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG10979104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker