Individual
SHARON SACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1411 S WOODLAND AVE, STE B, MICHIGAN CITY, IN 46360-7169
(219) 210-0111
(219) 879-2887
Mailing address
PO BOX 1083, MICHIGAN CITY, IN 46361-8283
(219) 926-8320
(219) 926-3524
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20041854A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000392276
BLUE CROSS & BLUE SHIELD
IN
01
—
202655005 01
SAGAMORE HEALTH PLAN
IN
Enumeration date
06/28/2006
Last updated
04/05/2010
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