Provider Demographics
NPI:1851971907
Name:COCAGNE, BREANNA MARIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARIE
Last Name:COCAGNE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 LAKESHORE BLVD APT 626
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6914
Mailing Address - Country:US
Mailing Address - Phone:734-999-7774
Mailing Address - Fax:
Practice Address - Street 1:3001 PLYMOUTH RD STE 101
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3205
Practice Address - Country:US
Practice Address - Phone:734-929-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511153571041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)