Provider Demographics
NPI:1356898449
Name:VANOVER, BROOKE CELIA (LCSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:CELIA
Last Name:VANOVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 BLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-6317
Mailing Address - Country:US
Mailing Address - Phone:818-451-5236
Mailing Address - Fax:
Practice Address - Street 1:3655 ALAMO ST STE 202
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063
Practice Address - Country:US
Practice Address - Phone:323-459-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW804831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical