Provider Demographics
NPI:1306229554
Name:BRILL, ROBERT JULIAN (LLMSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JULIAN
Last Name:BRILL
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7258 ORMOND RD
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2419
Mailing Address - Country:US
Mailing Address - Phone:248-431-1047
Mailing Address - Fax:
Practice Address - Street 1:4345 MEIGS AVE STE 104
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-1877
Practice Address - Country:US
Practice Address - Phone:248-431-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010974401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306229554Medicaid