Provider Demographics
NPI:1669261723
Name:CARDONA, BROOKE LYNN
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LYNN
Last Name:CARDONA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-2822
Mailing Address - Country:US
Mailing Address - Phone:508-916-8544
Mailing Address - Fax:
Practice Address - Street 1:500 KINGS HWY
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-4901
Practice Address - Country:US
Practice Address - Phone:774-634-7623
Practice Address - Fax:508-916-8544
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS41908843106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician