Healthcare Provider Details

I. General information

NPI: 1548577034
Provider Name (Legal Business Name): LAWRENCE BROOKS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 HOLLYWOOD BLVD SUITE 2
HOLLYWOOD FL
33021-6779
US

IV. Provider business mailing address

3810 HOLLYWOOD BLVD SUITE 2
HOLLYWOOD FL
33021-6779
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-3888
  • Fax: 954-962-3936
Mailing address:
  • Phone: 954-962-3888
  • Fax: 954-962-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY 8127
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 8127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: