MEDICARE: DANIELE LATRECE BROOKS MAED, MSW, LMSW

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	LSW0000008056	TN

General Provider Information

NPI Number	:	1629588694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELE LATRECE BROOKS MAED, MSW, LMSW

Provider Business Mailing Address
First Line	:	3515 W MARKET ST STE 120
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-4441
Country	:	US
Telephone Number	:	336-323-2660
Fax Number	:

Provider Business Practice Location Address
First Line	:	3515 W MARKET ST STE 120
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-4441
Country	:	US
Telephone Number	:	336-323-2660
Fax Number	:

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

Provider Enumeration Date	:	10/04/2017
Last Update Date	:	10/04/2017

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