Healthcare Provider Details

I. General information

NPI: 1104181627
Provider Name (Legal Business Name): CHRISTINA BROOKS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 URBANA PIKE STE 204
IJAMSVILLE MD
21754-9406
US

IV. Provider business mailing address

3280 URBANA PIKE STE 204
IJAMSVILLE MD
21754-9406
US

V. Phone/Fax

Practice location:
  • Phone: 240-549-0052
  • Fax:
Mailing address:
  • Phone: 240-549-0052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04873
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: