Provider Demographics
NPI:1255354353
Name:BROOKS, LAURA R, (MSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:R,
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 SAINT JOHNS LN # 3
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2605
Mailing Address - Country:US
Mailing Address - Phone:443-956-7282
Mailing Address - Fax:
Practice Address - Street 1:3355 SAINT JOHNS LN # 3
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2605
Practice Address - Country:US
Practice Address - Phone:443-956-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD054541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD341521000Medicaid