Provider Demographics
NPI:1063008209
Name:BROOKS, ALISSA (LCSW)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 S DORADO CIR APT 2G
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4634
Mailing Address - Country:US
Mailing Address - Phone:585-797-9270
Mailing Address - Fax:
Practice Address - Street 1:650 HALLOCK AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFF STA
Practice Address - State:NY
Practice Address - Zip Code:11776-1256
Practice Address - Country:US
Practice Address - Phone:631-403-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker