Basic Information
| Provider Information | |||||||||
| NPI: | 1033512249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKING-LANG | ||||||||
| FirstName: | CASSIDY | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1310 N 2ND ST APT 2220 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253607670 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9201 N 5TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850202532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808824545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2014 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 75939 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 75939 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW75939 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 19443 | AZ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.