Provider Demographics
NPI:1275609430
Name:SHKRELI-MOSED, LINDA (LMSW, LCSW, QMHP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SHKRELI-MOSED
Suffix:
Gender:F
Credentials:LMSW, LCSW, QMHP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:SHKRELI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44444 MOUND RD STE 600
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1354
Mailing Address - Country:US
Mailing Address - Phone:586-214-7787
Mailing Address - Fax:
Practice Address - Street 1:6218 WINDEMERE LN
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-5383
Practice Address - Country:US
Practice Address - Phone:586-221-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010723541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical