Provider Demographics
NPI:1962555623
Name:BROOKS, MICHAEL PHILIP (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PHILIP
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 1ST ST E
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6756
Mailing Address - Country:US
Mailing Address - Phone:707-996-4789
Mailing Address - Fax:
Practice Address - Street 1:414 1ST ST E
Practice Address - Street 2:SUITE 3
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6756
Practice Address - Country:US
Practice Address - Phone:707-996-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS81861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA157882OtherVALUEOPTIONS