Provider Demographics
NPI:1265082259
Name:BROOKS, GOLDEN CHEYENNE (BSW)
Entity type:Individual
Prefix:MISS
First Name:GOLDEN
Middle Name:CHEYENNE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 HARRISON PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1512
Mailing Address - Country:US
Mailing Address - Phone:347-232-2875
Mailing Address - Fax:
Practice Address - Street 1:184 HARRISON PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1512
Practice Address - Country:US
Practice Address - Phone:347-232-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health