Provider Demographics
NPI:1891463501
Name:BROOKS, CECILY MARIE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:CECILY
Middle Name:MARIE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 SHARWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1949
Mailing Address - Country:US
Mailing Address - Phone:202-431-3023
Mailing Address - Fax:
Practice Address - Street 1:354 MOUNTAIN RD STE G
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1158
Practice Address - Country:US
Practice Address - Phone:410-255-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5423133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered