Healthcare Provider Details

I. General information

NPI: 1669716247
Provider Name (Legal Business Name): LARRY BROOKS, PH.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SW 8TH ST STE 2185
MIAMI FL
33130-3004
US

IV. Provider business mailing address

3810 HOLLYWOOD BLVD STE 2
HOLLYWOOD FL
33021-6779
US

V. Phone/Fax

Practice location:
  • Phone: 786-303-1991
  • Fax:
Mailing address:
  • Phone: 786-303-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY8127
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY8127
License Number StateFL

VIII. Authorized Official

Name: JOSE FLORES
Title or Position: ACCOUNTS SPECIALIST
Credential:
Phone: 754-201-2265