Healthcare Provider Details

I. General information

NPI: 1588790935
Provider Name (Legal Business Name): PSYCHOLOGY ASSOCIATES OF THE KEWEENAW, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56730 CALUMET AVE STE F
CALUMET MI
49913-2968
US

IV. Provider business mailing address

56730 CALUMET AVE STE F
CALUMET MI
49913-2968
US

V. Phone/Fax

Practice location:
  • Phone: 906-337-6839
  • Fax: 906-337-0944
Mailing address:
  • Phone: 906-337-6839
  • Fax: 906-337-0944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007915
License Number StateMI

VIII. Authorized Official

Name: ROBERT WILLIAM SHARKEY
Title or Position: PRESIDENT
Credential: PH.D., LP
Phone: 906-337-6839