MEDICARE: MS. STEPHANIE BROOKS MSW, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MF00026	PA

General Provider Information

NPI Number	:	1043429517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE BROOKS MSW, LMFT

Provider Business Mailing Address
First Line	:	112 LINCOLN AVE
Second Line	:
City	:	YEADON
State	:	PA
Zip	:	19050-2933
Country	:	US
Telephone Number	:	610-622-5651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 RACE ST
Second Line	:	4TH FLOOR-403
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1119
Country	:	US
Telephone Number	:	215-762-6781
Fax Number	:	610-762-1153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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