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Individual
PHYLLIS BROOKS
Active
Individual
PHYLLIS BROOKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW LIC 1043921
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LICSW 104392-1
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
288764
MHN
MA
01
—
P03879
BCBS
MA
Enumeration date
12/20/2006
Last updated
07/08/2007
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