Provider Demographics
NPI:1326109752
Name:HATALSKY, SHERRY LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:LYNN
Last Name:HATALSKY
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 1:417 VALVERDE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-4475
Mailing Address - Country:US
Mailing Address - Phone:505-585-1355
Mailing Address - Fax:
Practice Address - Street 1:417 VALVERDE COMMONS DR
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-4475
Practice Address - Country:US
Practice Address - Phone:505-585-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 192381041C0700X
NMC-091941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical