Provider Demographics
NPI:1902100662
Name:FIERRO-SHARE, SOPHIE JO (LMSW)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:JO
Last Name:FIERRO-SHARE
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 1:1040 GORDON LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3742
Mailing Address - Country:US
Mailing Address - Phone:248-514-5409
Mailing Address - Fax:248-642-7966
Practice Address - Street 1:1040 GORDON LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-3742
Practice Address - Country:US
Practice Address - Phone:248-514-5409
Practice Address - Fax:248-642-7966
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010733361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical