Provider Demographics
NPI:1629627328
Name:DOLLOFF, BROOKLYN M
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:M
Last Name:DOLLOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27286 MIDWAY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2826
Mailing Address - Country:US
Mailing Address - Phone:989-388-6046
Mailing Address - Fax:
Practice Address - Street 1:2700 HAMLIN BLVD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2206
Practice Address - Country:US
Practice Address - Phone:734-261-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports