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General NPI Number Information
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NPI Number | 1649620196
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Entity Type | Individual
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Provider Name | BROOKE BALDREE LCSW 104948
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Gender | Female
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 2975 TREAT BLVD STE C5
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City | CONCORD
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State | CA
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Zip | 94518-3631
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Country | US
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Telephone | 925-771-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 2975 TREAT BLVD STE C5
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City | CONCORD
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State | CA
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Zip | 94518-3631
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Country | US
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Telephone | 925-493-2223
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 104948
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 71246
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 104948
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License Number State | CA
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