Provider Demographics
NPI:1013568401
Name:TODOROW, BRIAN CHARLES (LMSW, MA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CHARLES
Last Name:TODOROW
Suffix:
Gender:M
Credentials:LMSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8639 CANDLEWOOD ST APT 7
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2338
Mailing Address - Country:US
Mailing Address - Phone:734-417-6373
Mailing Address - Fax:
Practice Address - Street 1:8700 N 2ND ST STE 202
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1296
Practice Address - Country:US
Practice Address - Phone:810-522-0785
Practice Address - Fax:810-522-8155
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010828381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical