Provider Demographics
NPI:1255495859
Name:SHERIDAN-GUEST, ROSALIE A (LPC)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:A
Last Name:SHERIDAN-GUEST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-3518
Mailing Address - Country:US
Mailing Address - Phone:860-309-0338
Mailing Address - Fax:860-274-5672
Practice Address - Street 1:28 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3518
Practice Address - Country:US
Practice Address - Phone:860-309-0338
Practice Address - Fax:860-274-5672
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional