Provider Demographics
NPI:1245341270
Name:ROLL, BROOKS BENJAMIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:BROOKS
Middle Name:BENJAMIN
Last Name:ROLL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 STONEHOLLOW DR STE C
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2494
Mailing Address - Country:US
Mailing Address - Phone:281-812-7529
Mailing Address - Fax:281-812-3777
Practice Address - Street 1:1420 STONEHOLLOW DR STE C
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2494
Practice Address - Country:US
Practice Address - Phone:281-812-7529
Practice Address - Fax:281-812-3777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39450104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB102955OtherTRAILBLAZER