Provider Demographics
NPI:1013439728
Name:BRANTON, LISA L (MSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:BRANTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 E JOY RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9607
Mailing Address - Country:US
Mailing Address - Phone:734-645-0633
Mailing Address - Fax:
Practice Address - Street 1:5171 JACKSON RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1855
Practice Address - Country:US
Practice Address - Phone:734-649-6649
Practice Address - Fax:734-649-6649
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010978621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical