Provider Demographics
NPI:1841301454
Name:BROTSKY, SARAH R (PSYD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:R
Last Name:BROTSKY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 W LONG LAKE RD
Mailing Address - Street 2:100
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2769
Mailing Address - Country:US
Mailing Address - Phone:248-686-0355
Mailing Address - Fax:248-686-0355
Practice Address - Street 1:74 W LONG LAKE RD
Practice Address - Street 2:100
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2769
Practice Address - Country:US
Practice Address - Phone:248-686-0355
Practice Address - Fax:248-686-0355
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013021103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical