Healthcare Provider Details

I. General information

NPI: 1629627328
Provider Name (Legal Business Name): BROOKLYN M DOLLOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HAMLIN BLVD
INKSTER MI
48141-2206
US

IV. Provider business mailing address

27286 MIDWAY ST
DEARBORN HEIGHTS MI
48127-2826
US

V. Phone/Fax

Practice location:
  • Phone: 734-261-1842
  • Fax:
Mailing address:
  • Phone: 989-388-6046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: