Provider Demographics
NPI:1063205896
Name:BROOKS, JILL MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:CORINNA
Mailing Address - State:ME
Mailing Address - Zip Code:04928-3551
Mailing Address - Country:US
Mailing Address - Phone:207-299-6582
Mailing Address - Fax:
Practice Address - Street 1:80 BROWN RD
Practice Address - Street 2:
Practice Address - City:CORINNA
Practice Address - State:ME
Practice Address - Zip Code:04928-3551
Practice Address - Country:US
Practice Address - Phone:207-299-6582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-24
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS59211041S0200X
ME1-17-24983103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool