Provider Demographics
NPI:1124179460
Name:SHERRY, JAMES E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:SHERRY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 SUMMER ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5115
Mailing Address - Country:US
Mailing Address - Phone:203-324-3329
Mailing Address - Fax:
Practice Address - Street 1:1767 SUMMER ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5115
Practice Address - Country:US
Practice Address - Phone:203-324-3329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
800000797Medicare ID - Type Unspecified