Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CSW-1971 | CO |
NPI | 1003179458 |
---|---|
Provider Name | Diane Elizabeth Brooks |
First Address | Englewood, CO 80112-5095 |
Second Address | Englewood, CO 80112-5095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 25/06/2012 |