MEDICARE: MR. JOEL SIDNEY 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
1	1041C0700X	Clinical Social Worker	SW 1761	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477627859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL SIDNEY BROOKS LCSW

Provider Business Mailing Address
First Line	:	6237 EAGLEBROOK AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-1518
Country	:	US
Telephone Number	:	813-978-3960
Fax Number	:	813-978-0475

Provider Business Practice Location Address
First Line	:	3500 E FLETCHER AVE
Second Line	:	SUITE 129
City	:	TAMPA
State	:	FL
Zip	:	33613-4708
Country	:	US
Telephone Number	:	813-978-3960
Fax Number	:	813-978-0475

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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