Provider Demographics
NPI:1972270056
Name:SMITH, BROOKE CHARLOTTE (LMSW-CC)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:CHARLOTTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:MS
Other - First Name:BROOKE
Other - Middle Name:CHARLOTTE
Other - Last Name:GETCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 SWAN DR
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1206
Mailing Address - Country:US
Mailing Address - Phone:207-735-8621
Mailing Address - Fax:
Practice Address - Street 1:700 MOUNT HOPE AVE STE 320
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5664
Practice Address - Country:US
Practice Address - Phone:207-941-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC193991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical