Healthcare Provider Details

I. General information

NPI: 1902228059
Provider Name (Legal Business Name): LI BROOKENS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LI BROOKENS LCSW

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2769 IRIS AVE STE 118
BOULDER CO
80304
US

IV. Provider business mailing address

2769 IRIS AVE STE 118
BOULDER CO
80304-4405
US

V. Phone/Fax

Practice location:
  • Phone: 720-663-0163
  • Fax: 303-658-9871
Mailing address:
  • Phone: 720-663-0163
  • Fax: 303-658-9871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09923331
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: