Provider Demographics
NPI:1578659538
Name:SHEA, SARAH E (LMSW, PHD)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:E
Last Name:SHEA
Suffix:
Gender:F
Credentials:LMSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25401 HARPER AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2240
Mailing Address - Country:US
Mailing Address - Phone:586-466-6912
Mailing Address - Fax:
Practice Address - Street 1:25401 HARPER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2240
Practice Address - Country:US
Practice Address - Phone:586-466-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0769391041C0700X
MI68010916671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400020147Medicare PIN