Provider Demographics
NPI:1053350801
Name:BROOKS, ROBERT JONATHAN (LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JONATHAN
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8336
Mailing Address - Country:US
Mailing Address - Phone:540-898-5467
Mailing Address - Fax:
Practice Address - Street 1:3516 PLANK RD
Practice Address - Street 2:SUITE 5-C
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6861
Practice Address - Country:US
Practice Address - Phone:540-786-3049
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904000873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health