Provider Demographics
NPI:1164575619
Name:MAYSICK, SHARON CAIN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:CAIN
Last Name:MAYSICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 ATTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14428-9433
Mailing Address - Country:US
Mailing Address - Phone:585-293-3126
Mailing Address - Fax:
Practice Address - Street 1:3350 BROWN RD
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:NY
Practice Address - Zip Code:14423-9534
Practice Address - Country:US
Practice Address - Phone:585-538-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R036328-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132011FKOtherPREFERRED CARE
NY132011FKOtherPREFERRED CARE
NYP78949Medicare UPIN