Provider Demographics
NPI:1659416428
Name:BREEDEN, DAVID WILLIAM (MSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WILLIAM
Last Name:BREEDEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39293 PLYMOUTH RD
Mailing Address - Street 2:110
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1060
Mailing Address - Country:US
Mailing Address - Phone:248-258-6419
Mailing Address - Fax:
Practice Address - Street 1:39293 PLYMOUTH RD
Practice Address - Street 2:110
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1060
Practice Address - Country:US
Practice Address - Phone:248-258-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010152351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical