1427705003 NPI number — JACQUALINE MARGARET BROOKS MSW

Table of content: JACQUALINE MARGARET BROOKS MSW (NPI 1427705003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427705003 NPI number — JACQUALINE MARGARET BROOKS MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
JACQUALINE
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ASUQUO
Provider Other First Name:
JACQUALINE
Provider Other Middle Name:
BROOKS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1427705003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 SISALBED CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPITOL HEIGHTS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20743-3337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-828-0835
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 SISALBED CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPITOL HEIGHTS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20743-3337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-828-0835
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2022

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: 104100000X , with the licence number:  09309 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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