Brooke Helen Moller, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

080721-1 Issued in NY

Practice address

500 Pine St
Jamestown, NY 14701-5384

Phone

(716) 579-5270

NPI assigned

May 26, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Brooke Helen Gray Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429747200000",
    "number": "1750674545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PINE ST",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147015384",
            "telephone_number": "716-579-5270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PINE ST",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147015384",
            "telephone_number": "716-579-5270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLLER",
        "first_name": "BROOKE",
        "middle_name": "HELEN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-26",
        "last_updated": "2015-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "080721-1",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "080721-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "GRAY",
            "middle_name": "HELEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael D Mitchell, M.D.
• Phalguni Mitra, DDS
• Anthony Ansar Mohamed, M.D.
• Mohammad M Bari Physician PC
• Henry W Mole', O.D.
• Morgan E Monahan, OTR/L
• Satish K Mongia, MD PC
• Ella Mae Montaygne, LMSW
• Melody J Montemayor, L.P.N.
• Kelly J. Moon, RPH

• Clinical Social Worker in Jamestown, NY
• Providers in Jamestown, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.