Provider Demographics
NPI:1811200884
Name:BROOKS, KATRINA H
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:H
Last Name:BROOKS
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 1:152 CARSON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1303
Mailing Address - Country:US
Mailing Address - Phone:901-605-6779
Mailing Address - Fax:
Practice Address - Street 1:152 CARSON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127-1303
Practice Address - Country:US
Practice Address - Phone:901-605-6779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1693101Y00000X
ARA1411156101Y00000X
KY266674101Y00000X
PAPC008924101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor