Provider Demographics
NPI:1508595745
Name:BISMACK, SARAH (LMSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BISMACK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 BEAUPRE AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2620
Mailing Address - Country:US
Mailing Address - Phone:586-337-5110
Mailing Address - Fax:
Practice Address - Street 1:1271 BEAUPRE AVE
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2620
Practice Address - Country:US
Practice Address - Phone:586-337-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011142561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical