Organization Name: | DR. DIANE BROOKS, PSYD, PC |
NPI Number: | 1679867998 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DIANE JOYCE BROOKS (PRESIDENT) |
Mailing Address: | 170 Montauk Hway Speonk |
State: | NY US |
Postal Code: | 11972 |
Phone Number: | 6312883584 |
Fax Number: | 6312883584 |
NPI Enumeration Date: | 06/03/2011 |
NPI Last Update Date: | 06/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |