Provider Demographics
NPI:1184890998
Name:GENERETT, BROOKE NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:GENERETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 BRYANT ST
Mailing Address - Street 2:THE NUIN CENTER
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1511
Mailing Address - Country:US
Mailing Address - Phone:412-805-5273
Mailing Address - Fax:
Practice Address - Street 1:5655 BRYANT ST
Practice Address - Street 2:THE NUIN CENTER
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-1511
Practice Address - Country:US
Practice Address - Phone:412-805-5273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125755104100000X
PACW0170691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker