Provider Demographics
NPI:1073916318
Name:BROOKS, DWANETI ARICQUA
Entity type:Individual
Prefix:DR
First Name:DWANETI
Middle Name:ARICQUA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 W 139TH ST APT 2I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1509
Mailing Address - Country:US
Mailing Address - Phone:202-641-5983
Mailing Address - Fax:
Practice Address - Street 1:34 W 139TH ST APT 2I
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1509
Practice Address - Country:US
Practice Address - Phone:202-641-5983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst