MEDICARE: TERESA M BROOKS LISW-S

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	I8983	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	I8983	OTHER	OH	STATE OF OHIO COUNSELOR AND SOCIAL WORK BOARD

General Provider Information

NPI Number	:	1265962963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA M BROOKS LISW-S

Provider Business Mailing Address
First Line	:	7710 READING RD STE 112
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2809
Country	:	US
Telephone Number	:	513-429-3830
Fax Number	:

Provider Business Practice Location Address
First Line	:	7710 READING RD STE 112
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2809
Country	:	US
Telephone Number	:	513-429-3830
Fax Number	:	513-429-3830

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

Provider Enumeration Date	:	06/14/2017
Last Update Date	:	06/14/2017

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