Provider Demographics
NPI:1750954079
Name:ETTAHER, SABREEN K (MSW)
Entity type:Individual
Prefix:
First Name:SABREEN
Middle Name:K
Last Name:ETTAHER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 SAULINO CT
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1556
Mailing Address - Country:US
Mailing Address - Phone:313-842-7010
Mailing Address - Fax:313-574-5150
Practice Address - Street 1:6450 MAPLE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2259
Practice Address - Country:US
Practice Address - Phone:313-216-2200
Practice Address - Fax:313-584-3622
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511012781041S0200X
MI68011177441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool