Provider Demographics
NPI:1841220654
Name:HAMERINK, SALLY J (LMSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:J
Last Name:HAMERINK
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 1:159 S HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1615
Mailing Address - Country:US
Mailing Address - Phone:734-892-5899
Mailing Address - Fax:
Practice Address - Street 1:159 S HARVEY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1615
Practice Address - Country:US
Practice Address - Phone:734-895-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000902101YP2500X
MI68010597161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional