Provider Demographics
NPI:1417205980
Name:SHERMAN POLVINEN, LAURA (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SHERMAN POLVINEN
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 1:167 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER BY THE SEA
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1419
Mailing Address - Country:US
Mailing Address - Phone:978-236-3142
Mailing Address - Fax:
Practice Address - Street 1:167 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER BY THE SEA
Practice Address - State:MA
Practice Address - Zip Code:01944
Practice Address - Country:US
Practice Address - Phone:978-236-3142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical