Provider Demographics
NPI:1295875086
Name:BROOKS, JUDY ALICE (LCPC)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ALICE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347
Mailing Address - Country:US
Mailing Address - Phone:207-623-5242
Mailing Address - Fax:207-622-6988
Practice Address - Street 1:116 SECOND ST
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347
Practice Address - Country:US
Practice Address - Phone:207-623-5242
Practice Address - Fax:207-623-5242
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5060HV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
010573Medicare UPIN
1036596Medicare UPIN