MEDICARE: ROBERT JAY BROOKE MSW

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	CSW.00979013	CO
2	1041C0700X	Clinical Social Worker	CSW00979013	CO

General Provider Information

NPI Number	:	1669806774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JAY BROOKE MSW

Provider Business Mailing Address
First Line	:	310 E OLIVE ST
Second Line	:
City	:	LAMAR
State	:	CO
Zip	:	81052-2841
Country	:	US
Telephone Number	:	719-931-9844
Fax Number	:	719-931-8007

Provider Business Practice Location Address
First Line	:	310 E OLIVE ST
Second Line	:
City	:	LAMAR
State	:	CO
Zip	:	81052-2841
Country	:	US
Telephone Number	:	719-931-9844
Fax Number	:	719-931-8007

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

Provider Enumeration Date	:	08/26/2013
Last Update Date	:	12/07/2022

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