Provider Demographics
NPI:1144023755
Name:AHMEDANI, BRIAN (PHD, LMSW)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:AHMEDANI
Suffix:
Gender:M
Credentials:PHD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4526 LAKESHORE CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9779
Mailing Address - Country:US
Mailing Address - Phone:313-623-5684
Mailing Address - Fax:
Practice Address - Street 1:4526 LAKESHORE CT
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9779
Practice Address - Country:US
Practice Address - Phone:313-623-5684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-29
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010882381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical