1063200046 NPI number — CAROL MARIE BROSSIA LMSW

Table of content: CAROL MARIE BROSSIA LMSW (NPI 1063200046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063200046 NPI number — CAROL MARIE BROSSIA LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROSSIA
Provider First Name:
CAROL
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLAIR, BROSSIA, BLAIR-BROSSIA
Provider Other First Name:
CAROL
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063200046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41673 BEDFORD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48187-3703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-363-4513
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34290 FORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48185-3051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-813-8326
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com