Provider Demographics
NPI:1639269558
Name:MASEK, SHARON KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:MASEK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:KAY
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20072 E BALLANTYNE CT
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2427
Mailing Address - Country:US
Mailing Address - Phone:313-885-5393
Mailing Address - Fax:586-753-0404
Practice Address - Street 1:22708 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1823
Practice Address - Country:US
Practice Address - Phone:586-455-2210
Practice Address - Fax:586-445-0700
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010022241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ26426194Medicare ID - Type Unspecified
MIS27554Medicare UPIN