Provider Demographics
NPI:1972729440
Name:MORAN-SACKETT, MARSHA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:
Last Name:MORAN-SACKETT
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 1:30720 BARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1834
Mailing Address - Country:US
Mailing Address - Phone:248-585-6386
Mailing Address - Fax:
Practice Address - Street 1:18310 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2670
Practice Address - Country:US
Practice Address - Phone:248-557-7373
Practice Address - Fax:248-559-1140
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010010831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF37070047Medicare ID - Type UnspecifiedMEDICARE MEMBER #