Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 03127 | MD |
Y | 103T00000X | Psychologist | 03127 | MD |
NPI | 1003025123 |
---|---|
Provider Name | Dr. Kimberly Marlene Brooks |
First Address | Silver Spring, MD 20910-3355 |
Second Address | Silver Spring, MD 20910-3355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03127 | PROFESSIONAL LICENSE (01) | MD |
1802 | PROFESSIONAL LICENSE (01) | DC |