Provider Demographics
NPI:1114464617
Name:SHERIDAN, MAUREEN (LMSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 7TH AVE RM 801
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5655
Mailing Address - Country:US
Mailing Address - Phone:646-418-1171
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVE RM 801
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5655
Practice Address - Country:US
Practice Address - Phone:646-418-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097214104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker