Provider Demographics
NPI:1427406891
Name:SHOSHI, LAURA
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:SHOSHI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:SHOSHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:39423 VAN DYKE AVE
Mailing Address - Street 2:#404
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4641
Mailing Address - Country:US
Mailing Address - Phone:586-292-2192
Mailing Address - Fax:
Practice Address - Street 1:41400 DEQUINDRE RD
Practice Address - Street 2:#107
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3763
Practice Address - Country:US
Practice Address - Phone:586-466-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical