Provider Demographics
NPI:1285033225
Name:SHERIDAN, DAWNE MICHELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DAWNE
Middle Name:MICHELLE
Last Name:SHERIDAN
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 1:4201 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9324
Mailing Address - Country:US
Mailing Address - Phone:502-216-9045
Mailing Address - Fax:
Practice Address - Street 1:4201 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9324
Practice Address - Country:US
Practice Address - Phone:502-216-9045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1634OtherKENTUCKY BOARD OF SOCIAL WORK