Provider Demographics
NPI:1053454710
Name:CHEREWATY, DENISE E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:E
Last Name:CHEREWATY
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 1:4880 OAKLEY LANE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7765
Mailing Address - Country:US
Mailing Address - Phone:409-899-4014
Mailing Address - Fax:
Practice Address - Street 1:8109 GLADYS SUITE 103
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-8206
Practice Address - Country:US
Practice Address - Phone:409-899-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX275941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102894602Medicaid
TX82639WOtherBCBS
TXP00290669OtherRR MEDICARE
TXP00290669OtherRR MEDICARE