MEDICARE: KATRINA YVETTE 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	SW22431	FL

General Provider Information

NPI Number	:	1588432470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA YVETTE BROOKS LCSW

Provider Business Mailing Address
First Line	:	6067 FILLYSIDE TRL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-1882
Country	:	US
Telephone Number	:	904-831-4579
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 UNIVERSITY BLVD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-7550
Country	:	US
Telephone Number	:	904-496-5245
Fax Number	:	904-779-3309

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

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	12/19/2023

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