Provider Demographics
NPI:1558107961
Name:BROOKS PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:BROOKS PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TENESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-491-0650
Mailing Address - Street 1:61 N PLAINS INDUSTRIAL RD # 188
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5841
Mailing Address - Country:US
Mailing Address - Phone:203-491-0650
Mailing Address - Fax:203-303-9062
Practice Address - Street 1:816 OAK CENTER DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-9538
Practice Address - Country:US
Practice Address - Phone:203-491-0650
Practice Address - Fax:203-303-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)