Healthcare Provider Details

I. General information

NPI: 1548852882
Provider Name (Legal Business Name): BROOKE MACKENZIE WILLIAMS MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 05/08/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 RIDGE MILL DR
HILLIARD OH
43026-7752
US

IV. Provider business mailing address

3645 RIDGE MILL DR
HILLIARD OH
43026-7752
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-7876
  • Fax:
Mailing address:
  • Phone: 614-457-7876
  • Fax: 614-457-7896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2512104
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: