MEDICARE: ROBERT JONATHAN BROOKS LCSW, ACSW

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	101YM0800X	Mental Health Counselor	0904000873	VA

General Provider Information

NPI Number	:	1053350801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JONATHAN BROOKS LCSW, ACSW

Provider Business Mailing Address
First Line	:	6400 PROSPECT ST
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-8336
Country	:	US
Telephone Number	:	540-898-5467
Fax Number	:

Provider Business Practice Location Address
First Line	:	3516 PLANK RD
Second Line	:	SUITE 5-C
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-6861
Country	:	US
Telephone Number	:	540-786-3049
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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