Provider Demographics
NPI:1447318597
Name:WHITE, BROOKE (PHD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MAIN ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2932
Mailing Address - Country:US
Mailing Address - Phone:802-505-1748
Mailing Address - Fax:
Practice Address - Street 1:73 MAIN ST
Practice Address - Street 2:SUITE 19
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2932
Practice Address - Country:US
Practice Address - Phone:802-505-1748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0074506103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical