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General NPI Number Information
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NPI Number | 1669716247
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Entity Type | Organization
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Legal Business Name | LARRY BROOKS, PH.D., LLC
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 80 SW 8TH ST STE 2185
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City | MIAMI
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State | FL
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Zip | 33130-3004
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Country | US
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Telephone | 786-303-1991
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Fax |
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Provider Business Mailing Address
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Address Line | 3810 HOLLYWOOD BLVD STE 2
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6779
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Country | US
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Telephone | 786-303-1991
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Fax |
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Authorized Official
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Title or Position | ACCOUNTS SPECIALIST
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Name | JOSE FLORES
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Credential |
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Telephone | 754-201-2265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY8127
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY8127
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License Number State | FL
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