Provider Demographics
NPI:1598814774
Name:BROOKS, DIANE JOYCE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:JOYCE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 227
Mailing Address - Street 2:
Mailing Address - City:SPEONK
Mailing Address - State:NY
Mailing Address - Zip Code:11972-0227
Mailing Address - Country:US
Mailing Address - Phone:631-288-3584
Mailing Address - Fax:631-288-3584
Practice Address - Street 1:170 MONTAUK HWAY
Practice Address - Street 2:
Practice Address - City:SPEONK
Practice Address - State:NY
Practice Address - Zip Code:11972-0227
Practice Address - Country:US
Practice Address - Phone:631-288-3584
Practice Address - Fax:631-288-3584
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012849103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical