Provider Demographics
NPI:1063584571
Name:BRANDELL, JERROLD R (PHD, MSSW)
Entity type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:R
Last Name:BRANDELL
Suffix:
Gender:M
Credentials:PHD, MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 EAST WASHINGTON STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2017
Mailing Address - Country:US
Mailing Address - Phone:734-535-1400
Mailing Address - Fax:
Practice Address - Street 1:202 EAST WASHINGTON STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2017
Practice Address - Country:US
Practice Address - Phone:734-332-4761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010332251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical