Healthcare Provider Details

I. General information

NPI: 1366648370
Provider Name (Legal Business Name): JEANNIE SHAYNA BROOKS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 HOMEWOOD BLVD APT 217
DELRAY BEACH FL
33445-6894
US

IV. Provider business mailing address

1850 HOMEWOOD BLVD #217
DELRAY BEACH FL
33445-6918
US

V. Phone/Fax

Practice location:
  • Phone: 954-854-6145
  • Fax:
Mailing address:
  • Phone: 954-854-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number017781
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number017781
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number7961
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7961
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number7961
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number7961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: