Provider Demographics
NPI:1477391951
Name:FIELDS, BROOKE C (RBT)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:C
Last Name:FIELDS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 VANCE CIR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5416
Mailing Address - Country:US
Mailing Address - Phone:321-361-1011
Mailing Address - Fax:
Practice Address - Street 1:1244 WATER ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7053
Practice Address - Country:US
Practice Address - Phone:321-361-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-347497106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician