Provider Demographics
NPI:1265834980
Name:DR. JEANNIE S. BROOKS, PSYD, P.A.
Entity type:Organization
Organization Name:DR. JEANNIE S. BROOKS, PSYD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:SHAYNA
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-854-6145
Mailing Address - Street 1:1850 HOMEWOOD BLVD APT 217
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6894
Mailing Address - Country:US
Mailing Address - Phone:954-854-6145
Mailing Address - Fax:
Practice Address - Street 1:1850 HOMEWOOD BLVD APT 217
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6894
Practice Address - Country:US
Practice Address - Phone:954-854-6145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7961103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty