Provider Demographics
NPI:1346838109
Name:BARNES, BROOKE HANSON (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:HANSON
Last Name:BARNES
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:DOREEN
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LICSW
Mailing Address - Street 1:3527 S. FEDERAL WAY
Mailing Address - Street 2:STE 103 #1018
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705
Mailing Address - Country:US
Mailing Address - Phone:208-918-1359
Mailing Address - Fax:
Practice Address - Street 1:3527 S. FEDERAL WAY
Practice Address - Street 2:STE 103 #1018
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705
Practice Address - Country:US
Practice Address - Phone:208-918-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-37738104100000X
MALICSW1234111041C0700X
IDLCSW-405041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker