Provider Demographics
NPI:1942271929
Name:BRINKMANN, JULIA A (LMSW, ACSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:BRINKMANN
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2953 SATURN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1742
Mailing Address - Country:US
Mailing Address - Phone:248-568-0411
Mailing Address - Fax:248-625-8664
Practice Address - Street 1:5790 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2991
Practice Address - Country:US
Practice Address - Phone:248-568-0411
Practice Address - Fax:248-625-8664
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010640921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM34310Medicare ID - Type Unspecified