Provider Demographics
NPI:1780560250
Name:BROOKE HAVEN PLLC
Entity type:Organization
Organization Name:BROOKE HAVEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:CONOLY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:229-400-2625
Mailing Address - Street 1:7754 OKEECHOBEE BOULEVARD -583
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411
Mailing Address - Country:US
Mailing Address - Phone:229-400-2625
Mailing Address - Fax:
Practice Address - Street 1:7754 OKEECHOBEE BOULEVARD
Practice Address - Street 2:583
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411
Practice Address - Country:US
Practice Address - Phone:229-400-2625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)