Basic Information
| Provider Information | |||||||||
| NPI: | 1679064885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | BEVERLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 364 MUD TURTLE POND RD | ||||||||
| Address2: | |||||||||
| City: | ORFORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037774713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037261225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 228 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031035500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036225005 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2018 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.