Provider Demographics
NPI:1548577034
Name:BROOKS, LAWRENCE (PHD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
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 1:3810 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6779
Mailing Address - Country:US
Mailing Address - Phone:954-962-3888
Mailing Address - Fax:954-962-3936
Practice Address - Street 1:3810 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6779
Practice Address - Country:US
Practice Address - Phone:954-962-3888
Practice Address - Fax:954-962-3936
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8127103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist