Provider Demographics
NPI:1295240257
Name:ESMERALDA SHASKA LMSW, LLC
Entity type:Organization
Organization Name:ESMERALDA SHASKA LMSW, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SW
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESMERALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHASKA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-622-7583
Mailing Address - Street 1:1830 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3911
Mailing Address - Country:US
Mailing Address - Phone:313-622-7583
Mailing Address - Fax:
Practice Address - Street 1:415 S WEST ST STE 150
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2521
Practice Address - Country:US
Practice Address - Phone:313-622-7583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty