MEDICARE: DR. RONALD BRIAN BROOKS PH.D.

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	103TC0700X	Clinical Psychologist	PSY 8974	CA

General Provider Information

NPI Number	:	1477851681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD BRIAN BROOKS PH.D.

Provider Business Mailing Address
First Line	:	1335 STATE ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-2609
Country	:	US
Telephone Number	:	805-962-0266
Fax Number	:	805-898-9610

Provider Business Practice Location Address
First Line	:	629 STATE ST
Second Line	:	STE 203
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-7071
Country	:	US
Telephone Number	:	805-962-0266
Fax Number	:	805-898-9610

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

Provider Enumeration Date	:	03/11/2011
Last Update Date	:	01/06/2017

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