Provider Demographics
NPI:1972022929
Name:KIMBERLY M BROOKS, PHD, INC.
Entity Type:Organization
Organization Name:KIMBERLY M BROOKS, PHD, INC.
Other - Org Name:KIMBERLY M BROOKS, PH.D. & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARLENE
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-464-5129
Mailing Address - Street 1:3231 SUPERIOR LN STE A6
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1939
Mailing Address - Country:US
Mailing Address - Phone:301-464-5129
Mailing Address - Fax:301-718-1700
Practice Address - Street 1:3231 SUPERIOR LN STE A6
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1939
Practice Address - Country:US
Practice Address - Phone:301-464-5129
Practice Address - Fax:301-718-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03127103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty