Provider Demographics
NPI:1457043903
Name:SALAS, SHARON RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RENEE
Last Name:SALAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10593 SW JEM ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-7731
Mailing Address - Country:US
Mailing Address - Phone:954-651-7513
Mailing Address - Fax:
Practice Address - Street 1:10593 SW JEM ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-7731
Practice Address - Country:US
Practice Address - Phone:954-651-7513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical