MEDICARE: RENEE BROOKS LCSW

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	1041C0700X	Clinical Social Worker	34005945A	IN
2	163W00000X	Registered Nurse	33005190A	IN

General Provider Information

NPI Number	:	1376654814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE BROOKS LCSW

Provider Business Mailing Address
First Line	:	240 N TILLOTSON AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-3988
Country	:	US
Telephone Number	:	765-288-1928
Fax Number	:	765-741-0335

Provider Business Practice Location Address
First Line	:	2506 WILLOW BROOK PARKWAY
Second Line	:	SUITE 102
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1548
Country	:	US
Telephone Number	:	765-288-1928
Fax Number	:	765-741-0335

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/13/2012

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Directions to “ RENEE BROOKS LCSW” Practice Location

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