Provider Demographics
NPI:1730721234
Name:DUGAN, BROOKE NICOLE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:DUGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MAIN ST STE 520
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-2421
Mailing Address - Country:US
Mailing Address - Phone:212-362-4490
Mailing Address - Fax:
Practice Address - Street 1:235 MAIN ST STE 520
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2421
Practice Address - Country:US
Practice Address - Phone:212-362-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP102596101YM0800X
NY011931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health