Healthcare Provider Details

I. General information

NPI: 1003142415
Provider Name (Legal Business Name): SARINA LYNN BROOKS L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BARKER ST
CALAIS ME
04619-1404
US

IV. Provider business mailing address

36 S MAIN ST
WHITNEYVILLE ME
04654-4230
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-2745
  • Fax: 207-454-7387
Mailing address:
  • Phone: 207-255-9025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC11534
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: