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General NPI Number Information
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NPI Number | 1588432470
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Entity Type | Individual
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Provider Name | KATRINA YVETTE BROOKS LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 25 UNIVERSITY BLVD N
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City | JACKSONVILLE
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State | FL
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Zip | 32211-7550
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Country | US
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Telephone | 904-496-5245
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Fax | 904-779-3309
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Provider Business Mailing Address
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Address Line | 6067 FILLYSIDE TRL
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City | JACKSONVILLE
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State | FL
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Zip | 32244-1882
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Country | US
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Telephone | 904-831-4579
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW22431
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License Number State | FL
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