Provider Demographics
NPI:1083064869
Name:GERSKY, BRIANA-RAINE LILLY (LLMSW)
Entity Type:Individual
Prefix:
First Name:BRIANA-RAINE
Middle Name:LILLY
Last Name:GERSKY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:RAINE
Other - Last Name:LILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24367 COUNTRY SQUIRE ST APT 335
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-5708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24367 COUNTRY SQUIRE ST APT 335
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-5708
Practice Address - Country:US
Practice Address - Phone:586-943-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010996271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical