Healthcare Provider Details

I. General information

NPI: 1124033006
Provider Name (Legal Business Name): DANIEL BRZOZOWSKI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 WYOMING ST
MISSOULA MT
59801-1725
US

IV. Provider business mailing address

T-9 FORT MISSOULA
MISSOULA MT
59804-7202
US

V. Phone/Fax

Practice location:
  • Phone: 406-532-9700
  • Fax:
Mailing address:
  • Phone: 406-532-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number458
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: