Provider Demographics
NPI:1114270725
Name:BROOKS, CATHERINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:VERNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:730 PACIFICA WAY
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1341
Mailing Address - Country:US
Mailing Address - Phone:760-525-9656
Mailing Address - Fax:
Practice Address - Street 1:285 N EL CAMINO REAL
Practice Address - Street 2:SUITE 218
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5383
Practice Address - Country:US
Practice Address - Phone:760-525-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 270171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGZ017AOtherMEDICARE PTAN