Provider Demographics
NPI:1669806774
Name:BROOKE, ROBERT JAY (MSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAY
Last Name:BROOKE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:JAY
Other - Last Name:BROOKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:310 E OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-2841
Mailing Address - Country:US
Mailing Address - Phone:719-931-9844
Mailing Address - Fax:719-931-8007
Practice Address - Street 1:310 E OLIVE ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2841
Practice Address - Country:US
Practice Address - Phone:719-931-9844
Practice Address - Fax:719-931-8007
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.009790131041C0700X
COCSW009790131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical