Healthcare Provider Details

I. General information

NPI: 1487979753
Provider Name (Legal Business Name): ALAN EDWARD BROOKER PH.D., ABPP-CN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 CAPITOL AVE SUITE #2
SACRAMENTO CA
95816-5904
US

IV. Provider business mailing address

2609 CAPITOL AVE SUITE #2
SACRAMENTO CA
95816-5904
US

V. Phone/Fax

Practice location:
  • Phone: 916-446-6519
  • Fax: 916-448-2559
Mailing address:
  • Phone: 916-446-6519
  • Fax: 916-448-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY9414
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY9414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: