Provider Demographics
NPI:1699702704
Name:MAUCHLINE, SHERRY LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:MAUCHLINE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:38912 BRONSON DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2815
Mailing Address - Country:US
Mailing Address - Phone:586-977-1794
Mailing Address - Fax:586-795-2468
Practice Address - Street 1:37040 GARFIELD RD
Practice Address - Street 2:T 5
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3646
Practice Address - Country:US
Practice Address - Phone:586-977-1794
Practice Address - Fax:586-795-2468
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010174241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0890918OtherBLUE CROSS BLUE SHIELD
MI0890918Medicare ID - Type Unspecified