Provider Demographics
NPI:1386289676
Name:SHEPPARD-CUSUMANO, JORDAN (LMSW)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:SHEPPARD-CUSUMANO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:CUSUMANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:328 HIGGINS ST
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2070
Practice Address - Country:US
Practice Address - Phone:313-743-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical