Provider Demographics
NPI:1720409717
Name:BROOKS, ANTHONY (LMSW)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PACKARD # 120
Mailing Address - Street 2:AAVA-MHICM PROGRAM
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2703
Mailing Address - Country:US
Mailing Address - Phone:734-973-9345
Mailing Address - Fax:734-973-9353
Practice Address - Street 1:3800 PACKARD ST STE 120
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2073
Practice Address - Country:US
Practice Address - Phone:734-973-9345
Practice Address - Fax:734-973-9353
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010913401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical