Provider Demographics
NPI:1821424003
Name:DURRELL, BROOKE J (LCSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:J
Last Name:DURRELL
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 1:36914 AVENUE 12 UNIT 10
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8129
Mailing Address - Country:US
Mailing Address - Phone:559-514-4804
Mailing Address - Fax:
Practice Address - Street 1:36914 AVENUE 12 UNIT 10
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8129
Practice Address - Country:US
Practice Address - Phone:559-514-4804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA798981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000OtherN/A