Provider Demographics
NPI:1023116969
Name:ROSE, SHARON RUTH (LMSW)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:RUTH
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:RUTH
Other - Last Name:BOGUCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1496
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48090-1496
Mailing Address - Country:US
Mailing Address - Phone:586-741-5111
Mailing Address - Fax:586-806-0411
Practice Address - Street 1:28359 ALINE DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2675
Practice Address - Country:US
Practice Address - Phone:586-741-5111
Practice Address - Fax:586-806-0411
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801061422104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ26426106Medicare ID - Type Unspecified