Provider Demographics
NPI:1710518048
Name:WARD, BROOKE LEE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEE
Last Name:WARD
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 1:1681 EMPIRE BLVD BLDG B
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2290
Mailing Address - Country:US
Mailing Address - Phone:585-727-7685
Mailing Address - Fax:
Practice Address - Street 1:1681 EMPIRE BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2290
Practice Address - Country:US
Practice Address - Phone:585-727-7685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist