Provider Demographics
NPI:1780106948
Name:NORTON, BROOKE KIYO (PSYD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:KIYO
Last Name:NORTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:KIYO
Other - Last Name:WATANABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:47 6TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3092
Mailing Address - Country:US
Mailing Address - Phone:559-690-4700
Mailing Address - Fax:559-236-6077
Practice Address - Street 1:47 6TH ST STE 206
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3092
Practice Address - Country:US
Practice Address - Phone:559-690-4700
Practice Address - Fax:559-236-6077
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22447103T00000X, 103TC2200X, 103TH0004X, 103TH0100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service