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General NPI Number Information
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NPI Number | 1861165532
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Entity Type | Individual
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Provider Name | BROOKE T CAOUETTE LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 07/28/2021
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Provider Practice Location Address
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Address Line | 27130 PASEO ESPADA STE 522
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2719
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Country | US
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Telephone | 949-633-0482
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Fax |
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Provider Business Mailing Address
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Address Line | 33526 VALLEY VIEW CT
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City | DANA POINT
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State | CA
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Zip | 92629-1520
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Country | US
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Telephone | 949-293-3161
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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 | 98619
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License Number State | CA
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