Provider Demographics
NPI:1619778883
Name:BANDY, BROOKE ELLEN (LLMSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELLEN
Last Name:BANDY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 SOMERHILL LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4383
Mailing Address - Country:US
Mailing Address - Phone:248-877-0423
Mailing Address - Fax:
Practice Address - Street 1:41740 6 MILE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3463
Practice Address - Country:US
Practice Address - Phone:734-542-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511196931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical