Provider Demographics
NPI:1669962957
Name:O'GARA, BROOKE A (LMHC, LCDP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:O'GARA
Suffix:
Gender:F
Credentials:LMHC, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MENDON RD STE E-500
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4391
Mailing Address - Country:US
Mailing Address - Phone:401-439-4835
Mailing Address - Fax:401-574-2015
Practice Address - Street 1:1800 MENDON RD STE E-500
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4391
Practice Address - Country:US
Practice Address - Phone:401-439-4835
Practice Address - Fax:401-574-2015
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00810101YA0400X
RIMHC01251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)