Basic Information
| Provider Information | |||||||||
| NPI: | 1003142415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | SARINA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WHITNEYVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046544230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072559025 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10 BARKER ST | ||||||||
| Address2: | |||||||||
| City: | CALAIS | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046191404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074542745 | ||||||||
| FaxNumber: | 2074547387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2009 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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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 | 101YP2500X | LC11534 | ME | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 432911799 | 05 | ME | MEDICAID |