Provider Demographics
NPI:1760844344
Name:BROOKS, JANE P (EDD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:P
Last Name:BROOKS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JOFRAN LN
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4706
Mailing Address - Country:US
Mailing Address - Phone:203-637-8976
Mailing Address - Fax:
Practice Address - Street 1:6 JOFRAN LN
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4706
Practice Address - Country:US
Practice Address - Phone:203-637-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000016101YP2500X
NY014966-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist