Healthcare Provider Details

I. General information

NPI: 1922911387
Provider Name (Legal Business Name): LYDIA BROOKS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301A W PALMETTO PARK RD STE 100C
BOCA RATON FL
33433-3403
US

IV. Provider business mailing address

6784 W SAMPLE RD
CORAL SPRINGS FL
33067-4280
US

V. Phone/Fax

Practice location:
  • Phone: 954-248-1171
  • Fax:
Mailing address:
  • Phone: 954-254-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: