Provider Demographics
NPI:1689786394
Name:MACKEL, SHARON W (LISW)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:W
Last Name:MACKEL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 E 146TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-3729
Mailing Address - Country:US
Mailing Address - Phone:216-851-1853
Mailing Address - Fax:216-851-1865
Practice Address - Street 1:966 E 146TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-3729
Practice Address - Country:US
Practice Address - Phone:216-851-1853
Practice Address - Fax:216-851-1865
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00048461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRO9306801Medicare ID - Type UnspecifiedPART B
OHRO9306801Medicare ID - Type UnspecifiedMEDICARE PART B