MEDICARE: MRS. ANDREA LYNNE 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	74424	CA

General Provider Information

NPI Number	:	1629257027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA LYNNE BROOKS LCSW

Provider Business Mailing Address
First Line	:	103 SERRA CT
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-5231
Country	:	US
Telephone Number	:	831-216-8893
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 SERRA CT
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-5231
Country	:	US
Telephone Number	:	831-216-8893
Fax Number	:

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

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	05/11/2020

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