Provider Demographics
NPI:1528321973
Name:EUSEBI, SHARON MARIE (MA)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:MARIE
Last Name:EUSEBI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:SPRYSZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1090 NORTHOVER DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2033
Mailing Address - Country:US
Mailing Address - Phone:248-925-8658
Mailing Address - Fax:
Practice Address - Street 1:1090 NORTHOVER DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2033
Practice Address - Country:US
Practice Address - Phone:248-925-8658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health