Provider Demographics
NPI:1053852137
Name:SHERYLL WARING LPC LADC LLC
Entity Type:Organization
Organization Name:SHERYLL WARING LPC LADC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYLL
Authorized Official - Middle Name:
Authorized Official - Last Name:WARING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LADC
Authorized Official - Phone:860-933-5532
Mailing Address - Street 1:352 GRISWOLD ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1192
Mailing Address - Country:US
Mailing Address - Phone:860-933-5532
Mailing Address - Fax:860-430-6861
Practice Address - Street 1:33 PRATT ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1014
Practice Address - Country:US
Practice Address - Phone:860-933-5532
Practice Address - Fax:860-430-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000695101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1346405289Medicaid