Provider Demographics
NPI:1649620196
Name:BALDREE, BROOKE (LCSW 104948)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BALDREE
Suffix:
Gender:F
Credentials:LCSW 104948
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 TREAT BLVD STE C5
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3631
Mailing Address - Country:US
Mailing Address - Phone:925-493-2223
Mailing Address - Fax:
Practice Address - Street 1:2975 TREAT BLVD STE C5
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3631
Practice Address - Country:US
Practice Address - Phone:925-771-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104948101YM0800X, 1041C0700X
CA712461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3226912OtherSTATE OF CALIFORNIA