Provider Demographics
NPI:1407322290
Name:EDELBROCK, BRITTANY MARIE (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:MARIE
Last Name:EDELBROCK
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:MARIE
Other - Last Name:LUKASZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:214 NORTHRIDGE OVAL BLDG 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3218
Mailing Address - Country:US
Mailing Address - Phone:419-438-7606
Mailing Address - Fax:
Practice Address - Street 1:6200 ROCKSIDE WOODS BLVD N STE 305
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2343
Practice Address - Country:US
Practice Address - Phone:419-438-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22038591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical