Provider Demographics
NPI:1013051267
Name:WARNOCK-BROOKS, SUSAN ELEANOR (MFT AND LEP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELEANOR
Last Name:WARNOCK-BROOKS
Suffix:
Gender:F
Credentials:MFT AND LEP
Other - Prefix:MS
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:WARNOCK-BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT AND LEP
Mailing Address - Street 1:793 1ST ST W
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-7036
Mailing Address - Country:US
Mailing Address - Phone:707-996-9802
Mailing Address - Fax:
Practice Address - Street 1:793 1ST ST W
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-7036
Practice Address - Country:US
Practice Address - Phone:707-996-9802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1379103T00000X
CA15013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist