Active NPI
Bryan Frederick
- Clinical Social Worker
- Detroit, MI
National Provider Identifier
1114390507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 640 Temple St
Detroit, MI 48201-2599 - Phone
- (313) 344-9099
- NPI assigned
- Nov 5, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
640 Temple St
Detroit, MI 48201-2599
Mailing address
623 Oxford Rd
Ann Arbor, MI 48104-2654
Phone (734) 536-6276
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446681600000",
"number": "1114390507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "623 OXFORD RD",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481042654",
"telephone_number": "734-536-6276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 TEMPLE ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012599",
"telephone_number": "313-344-9099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICK",
"first_name": "BRYAN",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-11-05",
"last_updated": "2015-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.