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General NPI Number Information
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NPI Number | 1043314735
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Entity Type | Individual
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Provider Name | MARTHA JANE BROOKS LCSW MSSW
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Gender | Female
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 333 CAMPBELL DRIVE
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City | SNEEDVILLE
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State | TN
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Zip | 37869
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Country | US
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Telephone | 423-733-2216
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Fax | 423-733-2450
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Provider Business Mailing Address
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Address Line | PO BOX 9054
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City | GRAY
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State | TN
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Zip | 37615-9054
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Country | US
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Telephone | 423-467-3600
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Fax | 423-467-3696
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCSW1015
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License Number State | TN
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