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NPI Code Detail

MEDICARE: MS. REBECCA J BROOKS LCSW, LCAC

MEDICARE: MS. REBECCA J BROOKS LCSW, LCAC
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
11041C0700XClinical Social Worker34001902AIN
2101YA0400XAddiction (Substance Use Disorder) Counselor87000645AIN

General Provider Information

NPI Number : 1700860798
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. REBECCA J BROOKS LCSW, LCAC
Provider Business Mailing Address
First Line : 8320 MADISON AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-6066
Country : US
Telephone Number : 317-882-5122
Fax Number :
Provider Business Practice Location Address
First Line : 8320 MADISON AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-6066
Country : US
Telephone Number : 317-882-5122
Fax Number : 317-888-8642
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2005
Last Update Date : 04/03/2015

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