Provider Demographics
NPI:1124181094
Name:BORGLUM, SHERRI L (MA, LCAT, CASAC)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:L
Last Name:BORGLUM
Suffix:
Gender:F
Credentials:MA, LCAT, CASAC
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCAT, CASAC
Mailing Address - Street 1:4730 FERGUSON CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14544-9623
Mailing Address - Country:US
Mailing Address - Phone:716-785-4725
Mailing Address - Fax:
Practice Address - Street 1:21 MAIN ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527
Practice Address - Country:US
Practice Address - Phone:716-785-4725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCASAC11992101YA0400X
NYCASAC 11992101YA0400X
NYLCAT001267-1101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)