Provider Demographics
NPI:1265962963
Name:BROOKS, TERESA M (LISW-S)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 READING RD STE 112
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-2809
Mailing Address - Country:US
Mailing Address - Phone:513-429-3830
Mailing Address - Fax:
Practice Address - Street 1:7710 READING RD STE 112
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-2809
Practice Address - Country:US
Practice Address - Phone:513-429-3830
Practice Address - Fax:513-429-3830
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI89831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI8983OtherSTATE OF OHIO COUNSELOR AND SOCIAL WORK BOARD