Provider Demographics
NPI:1760631253
Name:EVANS, BROOKE S (LCSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:S
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 CORAL ST FL 1
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5135
Mailing Address - Country:US
Mailing Address - Phone:808-791-6079
Mailing Address - Fax:808-791-6081
Practice Address - Street 1:606 CORAL ST FL 1
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5135
Practice Address - Country:US
Practice Address - Phone:808-791-6079
Practice Address - Fax:808-791-6081
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 35061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical