Provider Demographics
NPI:1255476149
Name:CHERITT, JOHN STEPHAN (ACSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STEPHAN
Last Name:CHERITT
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S MAIN ST
Mailing Address - Street 2:STE 208
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3083
Mailing Address - Country:US
Mailing Address - Phone:810-664-4363
Mailing Address - Fax:810-664-4364
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:STE 208
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3083
Practice Address - Country:US
Practice Address - Phone:810-664-4363
Practice Address - Fax:810-664-4364
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010144491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0892742Medicare UPIN
MI0P06830Medicare UPIN