Provider Demographics
NPI:1386908309
Name:ALTONAGA, BROOKE LEE (LCSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEE
Last Name:ALTONAGA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:LAJOIE
Other - Last Name:LA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 BARTON BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3172
Mailing Address - Country:US
Mailing Address - Phone:321-504-3888
Mailing Address - Fax:321-504-3462
Practice Address - Street 1:500 BARTON BLVD STE 7
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3172
Practice Address - Country:US
Practice Address - Phone:321-504-3888
Practice Address - Fax:321-504-3462
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW120311041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health