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General NPI Number Information
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NPI Number | 1063008209
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Entity Type | Individual
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Provider Name | ALISSA BROOKS LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 650 HALLOCK AVE
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City | PORT JEFF STA
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State | NY
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Zip | 11776-1256
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Country | US
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Telephone | 631-403-3318
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Fax |
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Provider Business Mailing Address
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Address Line | 14 S DORADO CIR APT 2G
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City | HAUPPAUGE
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State | NY
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Zip | 11788-4634
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Country | US
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Telephone | 585-797-9270
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Fax |
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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 |
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License Number State |
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