Provider Demographics
NPI:1457603102
Name:BROOKS, FRIEDA B (LCSW)
Entity Type:Individual
Prefix:
First Name:FRIEDA
Middle Name:B
Last Name:BROOKS
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 1:6121 N THESTA ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8603
Mailing Address - Country:US
Mailing Address - Phone:559-438-7390
Mailing Address - Fax:559-438-7166
Practice Address - Street 1:6121 N THESTA ST
Practice Address - Street 2:SUITE 204
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8603
Practice Address - Country:US
Practice Address - Phone:559-438-7390
Practice Address - Fax:559-438-7166
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS165221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical