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NPI Code Detail

MEDICARE: CRYSTAL LYNN BROOKS LCSW

MEDICARE: CRYSTAL LYNN BROOKS LCSW
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
11041C0700XClinical Social Worker16911FL

General Provider Information

NPI Number : 1043989171
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL LYNN BROOKS LCSW
Provider Business Mailing Address
First Line : 73 S PALM AVE STE 215
Second Line :
City : SARASOTA
State : FL
Zip : 34236-5612
Country : US
Telephone Number : 941-960-0592
Fax Number :
Provider Business Practice Location Address
First Line : 73 S PALM AVE STE 215
Second Line :
City : SARASOTA
State : FL
Zip : 34236-5612
Country : US
Telephone Number : 941-960-0592
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2021
Last Update Date : 09/11/2021

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