MEDICARE: DR. TERRINA BROOKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1013508787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRINA BROOKS

Provider Business Mailing Address
First Line	:	6831 N 17TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-2738
Country	:	US
Telephone Number	:	484-393-5257
Fax Number	:

Provider Business Practice Location Address
First Line	:	6831 N 17TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-2738
Country	:	US
Telephone Number	:	484-393-5257
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2021
Last Update Date	:	01/26/2021

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Directions to “ DR. TERRINA BROOKS ” Practice Location

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