Provider Demographics
NPI:1144071119
Name:BROOKS, ELIZABETH (LSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3530
Mailing Address - Country:US
Mailing Address - Phone:732-481-4743
Mailing Address - Fax:
Practice Address - Street 1:105 UNION AVE
Practice Address - Street 2:
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730-1842
Practice Address - Country:US
Practice Address - Phone:732-481-4743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06258500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker