Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 050522-1 | NY |
NPI | 1003081647 |
---|---|
Provider Name | Douglas C. Brooks |
First Address | Staten Island, NY 10303-2123 |
Second Address | Brooklyn, NY 11201-5809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 24/04/2008 |