Healthcare Provider Details

I. General information

NPI: 1235629288
Provider Name (Legal Business Name): BRENDAN CEDAR TOTON MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date: 09/02/2024
Reactivation Date: 10/10/2024

III. Provider practice location address

305 W HURLBUT ST APT 17
CHARLEVOIX MI
49720-1298
US

IV. Provider business mailing address

1363 DOUGLAS DR STE 104
TRAVERSE CITY MI
49696-8980
US

V. Phone/Fax

Practice location:
  • Phone: 231-459-6639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number680117815
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: