Healthcare Provider Details

I. General information

NPI: 1811542442
Provider Name (Legal Business Name): BRIENNE HACKETT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22170 W 9 MILE RD
SOUTHFIELD MI
48033-6007
US

IV. Provider business mailing address

60 EASON ST
HIGHLAND PARK MI
48203-3708
US

V. Phone/Fax

Practice location:
  • Phone: 313-354-5594
  • Fax:
Mailing address:
  • Phone: 313-354-5594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801104734
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801104734
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: