Provider Demographics
NPI:1003025123
Name:BROOKS, KIMBERLY MARLENE (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARLENE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8607 2ND AVE
Mailing Address - Street 2:SUITE 506A
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3355
Mailing Address - Country:US
Mailing Address - Phone:301-589-1898
Mailing Address - Fax:301-589-2838
Practice Address - Street 1:8607 2ND AVE
Practice Address - Street 2:SUITE 506A
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3355
Practice Address - Country:US
Practice Address - Phone:301-589-1898
Practice Address - Fax:301-589-2838
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03127103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD03127OtherPROFESSIONAL LICENSE
DC1802OtherPROFESSIONAL LICENSE