Provider Demographics
NPI:1255505293
Name:SHERIDAN, ABBY T (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ABBY
Middle Name:T
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PLEASANT ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-5937
Mailing Address - Country:US
Mailing Address - Phone:978-879-3570
Mailing Address - Fax:978-283-2665
Practice Address - Street 1:19 PLEASANT ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-5937
Practice Address - Country:US
Practice Address - Phone:978-879-3570
Practice Address - Fax:978-283-2665
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2009-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1136481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical