Provider Demographics
NPI:1568795854
Name:MORTIMER, SHARON ROSEMARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ROSEMARIE
Last Name:MORTIMER
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 1:12205 72ND CT N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-1443
Mailing Address - Country:US
Mailing Address - Phone:561-784-1705
Mailing Address - Fax:
Practice Address - Street 1:12205 72ND CT N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33412-1443
Practice Address - Country:US
Practice Address - Phone:561-784-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00015221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical