Healthcare Provider Details

I. General information

NPI: 1386551851
Provider Name (Legal Business Name): SHELLY LYNN KOSMET LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 LITTLE ST
PORT HURON MI
48060-6829
US

IV. Provider business mailing address

3302 CORONET AVE
ORLANDO FL
32833-5345
US

V. Phone/Fax

Practice location:
  • Phone: 517-528-0369
  • Fax:
Mailing address:
  • Phone: 517-528-0369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851121091
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: