Provider Demographics
NPI:1275647653
Name:ANDERS, SHERRY LYNN (PHD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:ANDERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STOW RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-1845
Mailing Address - Country:US
Mailing Address - Phone:978-263-3359
Mailing Address - Fax:
Practice Address - Street 1:25 STOW RD
Practice Address - Street 2:UNIT B
Practice Address - City:BOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01719-1845
Practice Address - Country:US
Practice Address - Phone:978-263-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8156103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1859242Medicaid
MAW51250Medicare ID - Type Unspecified