Provider Demographics
NPI:1720571979
Name:SHARAF, MICHELE SUSAN (LICSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:SUSAN
Last Name:SHARAF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 HILLSIDE AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1228
Mailing Address - Country:US
Mailing Address - Phone:617-754-0549
Mailing Address - Fax:617-754-0701
Practice Address - Street 1:464 HILLSIDE AVE STE 304
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1228
Practice Address - Country:US
Practice Address - Phone:617-754-0549
Practice Address - Fax:617-754-0701
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10183121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical