Provider Demographics
NPI:1275182297
Name:FESSEL, SHERRY BETH (LCSW)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:BETH
Last Name:FESSEL
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 1:650 W END AVE # 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7355
Mailing Address - Country:US
Mailing Address - Phone:917-202-9685
Mailing Address - Fax:212-666-7470
Practice Address - Street 1:772 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5550
Practice Address - Country:US
Practice Address - Phone:212-222-6949
Practice Address - Fax:212-666-7470
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0780631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical