Provider Demographics
NPI:1568924884
Name:BROOKS, IRENE MERRITT (RADT)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MERRITT
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RADT
Mailing Address - Street 1:4610 MUIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2248
Mailing Address - Country:US
Mailing Address - Phone:619-316-5084
Mailing Address - Fax:
Practice Address - Street 1:336 OXFORD ST STE 209
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3122
Practice Address - Country:US
Practice Address - Phone:619-691-1662
Practice Address - Fax:619-691-1663
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)