Provider Demographics
NPI:1750871257
Name:SENIOR, BROOKE IRWIN (LGSW)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:IRWIN
Last Name:SENIOR
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 MORTON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1530
Mailing Address - Country:US
Mailing Address - Phone:610-247-3050
Mailing Address - Fax:
Practice Address - Street 1:2 TAFT CT STE 200
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1390
Practice Address - Country:US
Practice Address - Phone:301-715-3673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23682104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker