Healthcare Provider Details

I. General information

NPI: 1598933368
Provider Name (Legal Business Name): BRENDA J BOOKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 HODGSON MEMORIAL DR STE C1
SAVANNAH GA
31406-2540
US

IV. Provider business mailing address

125 BELLE GATE DR
POOLER GA
31322-9735
US

V. Phone/Fax

Practice location:
  • Phone: 912-344-9401
  • Fax:
Mailing address:
  • Phone: 217-836-2015
  • Fax: 912-335-5678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005413
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: