Provider Demographics
NPI:1982970018
Name:BROOKS, SYNTHIA ILEYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SYNTHIA
Middle Name:ILEYNE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3858 NOSTRAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2050
Mailing Address - Country:US
Mailing Address - Phone:929-253-8026
Mailing Address - Fax:
Practice Address - Street 1:1123 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5107
Practice Address - Country:US
Practice Address - Phone:929-253-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014900-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical