1326302555 NPI number — MRS. BROOKE ANDERSON SOVOCOOL LICSW

Table of content: MRS. BROOKE ANDERSON SOVOCOOL LICSW (NPI 1326302555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326302555 NPI number — MRS. BROOKE ANDERSON SOVOCOOL LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOVOCOOL
Provider First Name:
BROOKE
Provider Middle Name:
ANDERSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
BROOKE
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326302555
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 GOLDEN HILL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREWSBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01545-3041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-494-5004
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 IRVING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01609-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-799-3020
Provider Business Practice Location Address Fax Number:
508-799-8280
Provider Enumeration Date:
07/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041S0200X , with the licence number:  507087 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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