Provider Demographics
NPI:1821072315
Name:BROOKS, JAMES L (LAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 NW 57TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6425
Mailing Address - Country:US
Mailing Address - Phone:352-226-4433
Mailing Address - Fax:
Practice Address - Street 1:912 NW 57TH ST STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6425
Practice Address - Country:US
Practice Address - Phone:352-226-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2916171100000X
FLSW 121851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY045166Medicaid
NY045166Medicaid