Basic Information
Provider Information
NPI: 1003142415
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROOKS
FirstName: SARINA
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: L.C.S.W.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XLC11534MEY Behavioral Health & Social Service ProvidersCounselorProfessional

ID Information
IDTypeStateIssuerDescription
43291179905ME MEDICAID


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