Provider Demographics
NPI:1194890889
Name:BROOKER, DEBORAH J (PHD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:BROOKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MAIN ST.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:607-323-4110
Mailing Address - Fax:607-323-4109
Practice Address - Street 1:300 MAIN ST.
Practice Address - Street 2:SUITE 5
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-323-4110
Practice Address - Fax:607-323-4109
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0153551103TC0700X
NY015355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02348034Medicaid
NYDD3353Medicare UPIN