Healthcare Provider Details

I. General information

NPI: 1033421318
Provider Name (Legal Business Name): LILY SHAW GERSHENSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S 5TH AVE
ANN ARBOR MI
48104-2216
US

IV. Provider business mailing address

210 S 5TH AVE
ANN ARBOR MI
48104-2216
US

V. Phone/Fax

Practice location:
  • Phone: 734-615-6512
  • Fax:
Mailing address:
  • Phone: 734-615-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: