Provider Demographics
NPI:1982158721
Name:BROOKS, THOMAS (EDD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 WINDING WAY RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1820
Mailing Address - Country:US
Mailing Address - Phone:856-434-0145
Mailing Address - Fax:732-222-1103
Practice Address - Street 1:280 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1879
Practice Address - Country:US
Practice Address - Phone:732-222-1100
Practice Address - Fax:732-222-1103
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100413400103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral