Provider Demographics
NPI:1073965893
Name:MAYER, SHARON (MSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MAYER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 SIXTH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2381
Mailing Address - Country:US
Mailing Address - Phone:231-421-6921
Mailing Address - Fax:231-421-7852
Practice Address - Street 1:1014 SIXTH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2381
Practice Address - Country:US
Practice Address - Phone:231-421-6921
Practice Address - Fax:231-421-7852
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010670071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical