Healthcare Provider Details

I. General information

NPI: 1417001496
Provider Name (Legal Business Name): BROOKE D. SITZMANN-MCLOUGHLIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 B SOUTH BERKELEY LAKE RD.
NORCROSS GA
30071
US

IV. Provider business mailing address

4530 B SOUTH BERKELEY LAKE RD.
NORCROSS GA
30071
US

V. Phone/Fax

Practice location:
  • Phone: 770-417-2775
  • Fax:
Mailing address:
  • Phone: 770-417-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003065
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: