Provider Demographics
NPI:1134902901
Name:BROOKS, MIKAEL (LMSW)
Entity type:Individual
Prefix:
First Name:MIKAEL
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ROCKY HILL TER
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4845
Mailing Address - Country:US
Mailing Address - Phone:203-233-5753
Mailing Address - Fax:
Practice Address - Street 1:1438 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-2512
Practice Address - Country:US
Practice Address - Phone:203-583-8181
Practice Address - Fax:203-583-3850
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker