Provider Demographics
NPI:1447520879
Name:BROWN-LOBATO, BRANDELINE R (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:BRANDELINE
Middle Name:R
Last Name:BROWN-LOBATO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 S TELEGRAPH RD STE 220
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0183
Mailing Address - Country:US
Mailing Address - Phone:517-882-3732
Mailing Address - Fax:
Practice Address - Street 1:1760 S TELEGRAPH RD STE 220
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0183
Practice Address - Country:US
Practice Address - Phone:517-882-3732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-02
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57501041C0700X
MI68011194791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5750OtherLICENSED CLINICAL SOCIAL WORKER LICENSE
OK200548480AMedicaid