Provider Demographics
NPI:1154458024
Name:HAFERS, SHERYL ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANN
Last Name:HAFERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ACKERLY LN
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4549
Mailing Address - Country:US
Mailing Address - Phone:631-585-3070
Mailing Address - Fax:631-585-3070
Practice Address - Street 1:40 ACKERLY LN
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4549
Practice Address - Country:US
Practice Address - Phone:631-585-3070
Practice Address - Fax:631-585-3070
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075294-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical