Provider Demographics
NPI:1245663368
Name:BROOKS, JEANNINE
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12656 DULCINEA PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3149
Mailing Address - Country:US
Mailing Address - Phone:774-266-1294
Mailing Address - Fax:
Practice Address - Street 1:4301 N FEDERAL HWY SUITE 2 SOUTH
Practice Address - Street 2:BUTTERFLY EFFECTS LLC
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist