Provider Demographics
NPI:1043911431
Name:MARIK-ROACH, SHARI (LICSW)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:
Last Name:MARIK-ROACH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 GLENROSS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4006
Mailing Address - Country:US
Mailing Address - Phone:651-399-0979
Mailing Address - Fax:
Practice Address - Street 1:7200 GLENROSS RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4006
Practice Address - Country:US
Practice Address - Phone:651-399-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN245991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical