MEDICARE: BROOKE H BRODY LCSW-C, LCADC

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	1041C0700X	Clinical Social Worker	LCSW99030	CA

General Provider Information

NPI Number	:	1245613819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE H BRODY LCSW-C, LCADC

Provider Business Mailing Address
First Line	:	621A 2ND ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-5123
Country	:	US
Telephone Number	:	240-994-4926
Fax Number	:

Provider Business Practice Location Address
First Line	:	621A 2ND ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-5123
Country	:	US
Telephone Number	:	240-994-4926
Fax Number	:

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

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	03/14/2026

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