Provider Demographics
NPI:1033210190
Name:SHASKA-CHOMA, ESMERALDA (LMSW)
Entity Type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:
Last Name:SHASKA-CHOMA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ESMERALDA
Other - Middle Name:
Other - Last Name:SHASKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4646 JOHN R ST
Mailing Address - Street 2:11-MH
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1916
Mailing Address - Country:US
Mailing Address - Phone:313-576-4975
Mailing Address - Fax:313-576-3703
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:11-MH
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-4975
Practice Address - Fax:313-576-3703
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1295240257OtherTYPE 2 NPI