Provider Demographics
NPI:1861165532
Name:CAOUETTE, BROOKE T (LCSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:T
Last Name:CAOUETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33526 VALLEY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1520
Mailing Address - Country:US
Mailing Address - Phone:949-293-3161
Mailing Address - Fax:
Practice Address - Street 1:27130 PASEO ESPADA STE 522
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2719
Practice Address - Country:US
Practice Address - Phone:949-633-0482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health