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General NPI Number Information
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NPI Number | 1104468123
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Entity Type | Individual
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Provider Name | SHACARA B BURREL J.D, MSW,LLMSW
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Gender | Female
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 2970 S 9TH ST STE 9
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City | KALAMAZOO
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State | MI
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Zip | 49009-9493
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Country | US
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Telephone | 269-888-4046
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35
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City | OSHTEMO
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State | MI
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Zip | 49077-0035
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Country | US
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Telephone | 231-670-9761
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851105056
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6851105056
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801105056
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License Number State | MI
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