Provider Demographics
NPI:1326826801
Name:SHERIDAN, JESSICA LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2444
Mailing Address - Country:US
Mailing Address - Phone:315-246-5393
Mailing Address - Fax:
Practice Address - Street 1:267 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2444
Practice Address - Country:US
Practice Address - Phone:315-246-5393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health