Provider Demographics
NPI:1700404225
Name:SHAMON, MARY ANN (LLMSW)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:SHAMON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:42449 TESSMER DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3062
Mailing Address - Country:US
Mailing Address - Phone:248-346-1248
Mailing Address - Fax:
Practice Address - Street 1:28303 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3040
Practice Address - Country:US
Practice Address - Phone:248-658-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011069501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical