Provider Demographics
NPI:1063608164
Name:BROOKS, WILLIAM (MSSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4178 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6907
Mailing Address - Country:US
Mailing Address - Phone:414-324-1920
Mailing Address - Fax:414-265-7179
Practice Address - Street 1:4178 N 14TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6907
Practice Address - Country:US
Practice Address - Phone:414-324-1920
Practice Address - Fax:414-265-7179
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1073-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6082219883Medicaid