Provider Demographics
NPI:1831785815
Name:BROOKS, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40501 ROAD 222 APT 104
Mailing Address - Street 2:
Mailing Address - City:BASS LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93604-9780
Mailing Address - Country:US
Mailing Address - Phone:209-765-0308
Mailing Address - Fax:
Practice Address - Street 1:6770 N WEST AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-1399
Practice Address - Country:US
Practice Address - Phone:209-765-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician