Provider Demographics
NPI:1487979753
Name:BROOKER, ALAN EDWARD (PHD, ABPP-CN)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:EDWARD
Last Name:BROOKER
Suffix:
Gender:M
Credentials:PHD, ABPP-CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 CAPITOL AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5904
Mailing Address - Country:US
Mailing Address - Phone:916-446-6519
Mailing Address - Fax:916-448-2559
Practice Address - Street 1:2609 CAPITOL AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5904
Practice Address - Country:US
Practice Address - Phone:916-446-6519
Practice Address - Fax:916-448-2559
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9414103G00000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADG379AMedicare PIN