Provider Demographics
NPI:1215660659
Name:MAKETO, SIARRA ADERONKE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SIARRA
Middle Name:ADERONKE
Last Name:MAKETO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SIARRA
Other - Middle Name:
Other - Last Name:ADEGBOYEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:9477 ESSEX ST.
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174
Mailing Address - Country:US
Mailing Address - Phone:313-808-8021
Mailing Address - Fax:
Practice Address - Street 1:125 GOVERNORS SQ STE D
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4871
Practice Address - Country:US
Practice Address - Phone:678-423-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511003441041C0700X
GACSW0094351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty