Provider Demographics
NPI:1588432470
Name:BROOKS, KATRINA YVETTE (LCSW)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:YVETTE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6067 FILLYSIDE TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-1882
Mailing Address - Country:US
Mailing Address - Phone:904-831-4579
Mailing Address - Fax:
Practice Address - Street 1:25 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-7550
Practice Address - Country:US
Practice Address - Phone:904-496-5245
Practice Address - Fax:904-779-3309
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW224311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical