Provider Demographics
NPI:1174503403
Name:BROOKS, DAVID MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 N LAKE SHORE DR # 5E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3301
Mailing Address - Country:US
Mailing Address - Phone:310-498-0555
Mailing Address - Fax:
Practice Address - Street 1:3800 N LAKE SHORE DR # 5E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3301
Practice Address - Country:US
Practice Address - Phone:310-498-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20877103TC0700X
IL071.009978103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174503403OtherCIGNA HEALTHCARE/CBH
CA1174503403OtherUNITED HEALTHCARE
1143651OtherCAQH IDENTIFIER
CAOPL208770OtherBLUE SHIELD OF CALIFORNIA
CAW20435OtherMEDICARE GROUP ID
CAW20435OtherMEDICARE GROUP ID