Provider Demographics
NPI:1427226158
Name:SHALASH, HANEEN (MSW)
Entity Type:Individual
Prefix:
First Name:HANEEN
Middle Name:
Last Name:SHALASH
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 1:4625 W PITCH PINE LN
Mailing Address - Street 2:3A
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4992
Mailing Address - Country:US
Mailing Address - Phone:313-581-7287
Mailing Address - Fax:313-581-7318
Practice Address - Street 1:4625 W PITCH PINE LN
Practice Address - Street 2:3A
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4992
Practice Address - Country:US
Practice Address - Phone:313-581-7287
Practice Address - Fax:313-581-7318
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid