Provider Demographics
NPI:1245671312
Name:SCOTT, SHERRY REGINA (LMSW)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:REGINA
Last Name:SCOTT
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16021 DUGAN ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-1480
Mailing Address - Country:US
Mailing Address - Phone:586-738-4374
Mailing Address - Fax:
Practice Address - Street 1:2900 HILTON RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1017
Practice Address - Country:US
Practice Address - Phone:586-738-4374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801115505261QA0600X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1659923159Medicaid
MI1245671312Medicaid