Provider Demographics
NPI:1043658404
Name:PICOTTE, BROOKE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:PICOTTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:PICOTTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, PSYD
Mailing Address - Street 1:20 CORPORATE WOODS BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2396
Mailing Address - Country:US
Mailing Address - Phone:917-921-2602
Mailing Address - Fax:
Practice Address - Street 1:20 CORPORATE WOODS BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211-2396
Practice Address - Country:US
Practice Address - Phone:917-921-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018551-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist