Provider Demographics
NPI:1053882118
Name:BROCKERT, CARLENE J (LMSW)
Entity type:Individual
Prefix:
First Name:CARLENE
Middle Name:J
Last Name:BROCKERT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22309 MYLLS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1342
Mailing Address - Country:US
Mailing Address - Phone:586-944-4790
Mailing Address - Fax:248-800-3336
Practice Address - Street 1:450 BREWER RD
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:MI
Practice Address - Zip Code:48367-4008
Practice Address - Country:US
Practice Address - Phone:586-944-4790
Practice Address - Fax:248-800-3336
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010928551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical