Provider Demographics
NPI:1013007152
Name:ROLDAN, SHERRY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 60 108TH ST
Mailing Address - Street 2:APT 420
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4323
Mailing Address - Country:US
Mailing Address - Phone:718-793-2679
Mailing Address - Fax:
Practice Address - Street 1:37-20 76TH STREET
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-478-1526
Practice Address - Fax:718-429-0738
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032259-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03823PMedicare ID - Type UnspecifiedGHI MEDICARE
NYNP5711Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NYP22441Medicare UPIN