Healthcare Provider Details

I. General information

NPI: 1912046970
Provider Name (Legal Business Name): BRANDY MICHELLE BROOKS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 CONEY ISLAND AVE
BROOKLYN NY
11230-5849
US

IV. Provider business mailing address

45 WREN DR
ROSLYN NY
11576-2715
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-1415
  • Fax:
Mailing address:
  • Phone: 516-996-9847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number018154
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: