Provider Demographics
NPI:1326546458
Name:WEBER, BROOK STAR (LICSW)
Entity type:Individual
Prefix:
First Name:BROOK
Middle Name:STAR
Last Name:WEBER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:BROOK
Other - Middle Name:STAR
Other - Last Name:SILVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:200 NORTH BERNARD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201
Mailing Address - Country:US
Mailing Address - Phone:509-354-2416
Mailing Address - Fax:509-824-8630
Practice Address - Street 1:5102 N DRISCOLL BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205
Practice Address - Country:US
Practice Address - Phone:509-354-2416
Practice Address - Fax:509-824-8630
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-37273104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker