MEDICARE: DR. JEANNIE S. BROOKS, PSYD, P.A.

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	103TF0200X	Forensic Psychologist	PY7961	FL
2	103TC0700X	Clinical Psychologist	PY7961	FL

General Provider Information

NPI Number	:	1265834980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JEANNIE S. BROOKS, PSYD, P.A.

Provider Business Mailing Address
First Line	:	1850 HOMEWOOD BLVD APT 217
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6894
Country	:	US
Telephone Number	:	954-854-6145
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 HOMEWOOD BLVD APT 217
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6894
Country	:	US
Telephone Number	:	954-854-6145
Fax Number	:

Authorized Official
Title or Position	:	OFFICER/DIRECTOR
Name	:	DR. JEANNIE SHAYNA BROOKS
Credential	:	PSYD
Telephone Number	:	954-854-6145

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	09/24/2014

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