Provider Demographics
NPI:1174680847
Name:SEYMOUR, SHERRY ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:ANN
Last Name:SEYMOUR
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 1:3252 HOLIDAY CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0027
Mailing Address - Country:US
Mailing Address - Phone:858-793-3460
Mailing Address - Fax:858-793-3460
Practice Address - Street 1:3252 HOLIDAY CT
Practice Address - Street 2:SUITE 102
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0027
Practice Address - Country:US
Practice Address - Phone:858-793-3460
Practice Address - Fax:858-793-3460
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 0054591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical