Provider Demographics
NPI:1124288303
Name:SPARROW, NANCY (LMSW, LMFT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SPARROW
Suffix:
Gender:F
Credentials:LMSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 N ALTADENA AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-4202
Mailing Address - Country:US
Mailing Address - Phone:248-336-8920
Mailing Address - Fax:281-497-3512
Practice Address - Street 1:706 N ALTADENA AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-4202
Practice Address - Country:US
Practice Address - Phone:248-336-8920
Practice Address - Fax:281-497-3512
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010196781041C0700X
MI4101005640106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8779088476Medicare PIN