Healthcare Provider Details

I. General information

NPI: 1689021628
Provider Name (Legal Business Name): ROSEMARY BREWER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 W MAPLE RD STE 195
WEST BLOOMFIELD MI
48322-2275
US

IV. Provider business mailing address

PO BOX 223220
PITTSBURGH PA
15251-2220
US

V. Phone/Fax

Practice location:
  • Phone: 844-503-1848
  • Fax:
Mailing address:
  • Phone: 248-831-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001072
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: