Provider Demographics
NPI:1659474179
Name:BROOKS, RENANA E (PHD)
Entity Type:Individual
Prefix:MRS
First Name:RENANA
Middle Name:E
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 I ST NW
Mailing Address - Street 2:STE 700
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006
Mailing Address - Country:US
Mailing Address - Phone:202-783-0775
Mailing Address - Fax:202-783-0776
Practice Address - Street 1:1634 I ST NW
Practice Address - Street 2:STE 700
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:202-783-0775
Practice Address - Fax:202-783-0776
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1611103T00000X
MD02652103T00000X
VA0810001757103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R28861Medicare UPIN
DC653010Medicare ID - Type Unspecified