Provider Demographics
NPI:1194074419
Name:RITSON, BRIAN D (MSW STUDENT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:RITSON
Suffix:
Gender:M
Credentials:MSW STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2892
Mailing Address - Country:US
Mailing Address - Phone:313-415-7622
Mailing Address - Fax:313-221-9908
Practice Address - Street 1:2240 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2892
Practice Address - Country:US
Practice Address - Phone:313-415-7622
Practice Address - Fax:313-221-9908
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical