Provider Demographics
NPI:1265731236
Name:BROOKS, MICHELL (MSS, LCSW)
Entity type:Individual
Prefix:
First Name:MICHELL
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1236
Mailing Address - Country:US
Mailing Address - Phone:610-644-6464
Mailing Address - Fax:610-644-4066
Practice Address - Street 1:234 S BRYN MAWR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2133
Practice Address - Country:US
Practice Address - Phone:610-644-6464
Practice Address - Fax:610-525-2552
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0155641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical