Provider Demographics
NPI:1225128606
Name:SHERMAN, MAUDENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MAUDENE
Middle Name:
Last Name:SHERMAN
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:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413-0453
Mailing Address - Country:US
Mailing Address - Phone:757-665-1260
Mailing Address - Fax:757-665-4184
Practice Address - Street 1:19056 GREENBUSH RD
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421
Practice Address - Country:US
Practice Address - Phone:757-665-1260
Practice Address - Fax:757-665-4184
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945417Medicaid
VA285310OtherHEALTHKEEPERS
VAC05541OtherMEDICARE GROUP
VA135834OtherVALUE OPTIONS
VA394183OtherANTHEM
VA251687OtherUNITED BEHAVIORAL HEALTH
VA89386OtherSENTARA
VA89386OtherSENTARA