Provider Demographics
NPI:1023681749
Name:AVON, BROOKE ANN (LMHC)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ANN
Last Name:AVON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WARREN ST STE 209
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4558
Mailing Address - Country:US
Mailing Address - Phone:518-338-3117
Mailing Address - Fax:518-831-5944
Practice Address - Street 1:5 WARREN ST STE 209
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4558
Practice Address - Country:US
Practice Address - Phone:518-338-3117
Practice Address - Fax:518-831-5944
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011495-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health