Provider Demographics
NPI:1720787971
Name:BRICKMAN, KATHRYN L (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:BRICKMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9163 SUNDANCE TRL
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-8651
Mailing Address - Country:US
Mailing Address - Phone:734-239-2257
Mailing Address - Fax:
Practice Address - Street 1:1145 POMONA RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3044
Practice Address - Country:US
Practice Address - Phone:734-239-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010932351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical