Provider Demographics
NPI:1942923396
Name:LEDERER, BROOKE ROCHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ROCHELLE
Last Name:LEDERER
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 1:1507 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4909
Mailing Address - Country:US
Mailing Address - Phone:970-366-2023
Mailing Address - Fax:
Practice Address - Street 1:1507 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4909
Practice Address - Country:US
Practice Address - Phone:970-366-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical