Provider Demographics
NPI:1073635801
Name:BRANTLEY, ROSALIND S (LLMSW)
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:S
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26650 EUREKA RD STE A
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4835
Mailing Address - Country:US
Mailing Address - Phone:313-961-3700
Mailing Address - Fax:
Practice Address - Street 1:26650 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4835
Practice Address - Country:US
Practice Address - Phone:734-955-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011012561041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool