Healthcare Provider Details

I. General information

NPI: 1407563562
Provider Name (Legal Business Name): KIMBERLY-MARIE M BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523 CLEMENT AVE
ALAMEDA CA
94501-1522
US

IV. Provider business mailing address

2523 CLEMENT AVE
ALAMEDA CA
94501-1522
US

V. Phone/Fax

Practice location:
  • Phone: 510-629-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number125414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: