Provider Demographics
NPI:1235902479
Name:SHERIDAN, SUMMER MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:MARIE
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:M
Other - Last Name:SHERIDAN-ZABRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2816 FREDERICK DOUGLASS BLVD APT 2G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-2114
Mailing Address - Country:US
Mailing Address - Phone:646-470-0521
Mailing Address - Fax:
Practice Address - Street 1:295 CENTRAL PARK W OFC 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3021
Practice Address - Country:US
Practice Address - Phone:646-470-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080516-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical