Provider Demographics
NPI:1306273024
Name:HARRELL, CHERYL DIANE (LICSW)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:DIANE
Last Name:HARRELL
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 1:8 GOFFE ST
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9559
Mailing Address - Country:US
Mailing Address - Phone:413-424-3818
Mailing Address - Fax:
Practice Address - Street 1:8 GOFFE ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9559
Practice Address - Country:US
Practice Address - Phone:413-424-3818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
MA10178891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHAP05089OtherBCBS
MAA015745OtherVALUEOPTIONS/HARVARD PILGRIM