Provider Demographics
NPI:1639686272
Name:LONGBUCCO, SHARON (LMSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:LONGBUCCO
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 1:5445 ALI DR DEPT 320
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-5193
Mailing Address - Country:US
Mailing Address - Phone:810-428-1181
Mailing Address - Fax:810-426-0009
Practice Address - Street 1:5445 ALI DR DEPT 320
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5193
Practice Address - Country:US
Practice Address - Phone:810-428-1181
Practice Address - Fax:810-426-0009
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010874201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801087420OtherLICENSE