Provider Demographics
NPI:1952914590
Name:BROOKS, TESIA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:TESIA
Middle Name:MARIE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11980-0501
Mailing Address - Country:US
Mailing Address - Phone:631-379-5637
Mailing Address - Fax:
Practice Address - Street 1:19 2ND ST
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-1912
Practice Address - Country:US
Practice Address - Phone:631-305-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2023-11-01
Deactivation Date:2023-10-24
Deactivation Code:
Reactivation Date:2023-10-31
Provider Licenses
StateLicense IDTaxonomies
NY102014104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker