Provider Demographics
NPI:1942218557
Name:BROOKS, JAMES DAWSON (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAWSON
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7272 WURZBACH RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4801
Mailing Address - Country:US
Mailing Address - Phone:210-615-8880
Mailing Address - Fax:210-615-3401
Practice Address - Street 1:1655 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3429
Practice Address - Country:US
Practice Address - Phone:800-275-3243
Practice Address - Fax:718-854-8308
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31513103TC0700X
NY008532-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150649502Medicaid
TX150649503Medicaid
TX150649503Medicaid
TX83372PMedicare ID - Type Unspecified00R03T DOMHA TX