Provider Demographics
NPI:1073202404
Name:SHIVE, CHERYL (MS, MSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SHIVE
Suffix:
Gender:F
Credentials:MS, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 STONE WALL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-9324
Mailing Address - Country:US
Mailing Address - Phone:301-529-7136
Mailing Address - Fax:
Practice Address - Street 1:112 LAKE ST STE 240
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5284
Practice Address - Country:US
Practice Address - Phone:802-865-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0134423101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor