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NPI Code Detail

MEDICARE: MS. KATHLEEN MARIE BROOKS LMSW, CASAC

MEDICARE: MS. KATHLEEN MARIE BROOKS LMSW, CASAC
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
1104100000XSocial Worker081674NY

General Provider Information

NPI Number : 1588838221
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHLEEN MARIE BROOKS LMSW, CASAC
Provider Business Mailing Address
First Line : 6050 60TH DR
Second Line :
City : MASPETH
State : NY
Zip : 11378-3534
Country : US
Telephone Number : 718-628-1620
Fax Number :
Provider Business Practice Location Address
First Line : 2976 NORTHERN BLVD
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-2822
Country : US
Telephone Number : 718-906-9475
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2008
Last Update Date : 07/21/2022

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