Provider Demographics
NPI:1720405418
Name:DAFTUAR, BRITTNEY (LMSW)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:DAFTUAR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BRITTNEY
Other - Middle Name:
Other - Last Name:DELUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2888 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2612
Mailing Address - Country:US
Mailing Address - Phone:313-875-5051
Mailing Address - Fax:248-322-5787
Practice Address - Street 1:2888 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2612
Practice Address - Country:US
Practice Address - Phone:313-875-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010921931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical