Provider Demographics
NPI:1750421038
Name:MCNEIL, SHARON MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2941
Mailing Address - Country:US
Mailing Address - Phone:734-240-2811
Mailing Address - Fax:
Practice Address - Street 1:12 E 3RD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1258
Practice Address - Country:US
Practice Address - Phone:517-775-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010599591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P21370Medicare ID - Type UnspecifiedLOCALITY FEE 099