Provider Demographics
NPI:1558500223
Name:DAVID M BROOKS PHD PSYCHOLOGICAL SERVICES PC
Entity type:Organization
Organization Name:DAVID M BROOKS PHD PSYCHOLOGICAL SERVICES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-498-0555
Mailing Address - Street 1:3800 N LAKE SHORE DR # 5E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3301
Mailing Address - Country:US
Mailing Address - Phone:310-498-0555
Mailing Address - Fax:
Practice Address - Street 1:3800 N LAKE SHORE DR # 5E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3301
Practice Address - Country:US
Practice Address - Phone:310-498-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20877103TC0700X, 103TP0814X
103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174503403OtherCIGNA HEALTHCARE/CBH
CAZZZ56245YOtherBLUE SHIELD OF CALIFORNIA
CA1174503403OtherUNITED BEHAVIORAL HEALTH
CA=========OtherAETNA
CAZZZ56245YOtherBLUE SHIELD OF CALIFORNIA