Provider Demographics
NPI:1710618863
Name:BREEN, ANDREW (LMSW)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BREEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8380 HOLCOMB RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4316
Mailing Address - Country:US
Mailing Address - Phone:248-807-2196
Mailing Address - Fax:
Practice Address - Street 1:8380 HOLCOMB RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4316
Practice Address - Country:US
Practice Address - Phone:248-807-2196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011122781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical