Provider Demographics
NPI:1417326638
Name:SHERIDAN, MARIA (MED, EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:MED, EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 CHILDS LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-2124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 VIRGINIA AVE NW STE 901
Practice Address - Street 2:KIPP DC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1930
Practice Address - Country:US
Practice Address - Phone:202-904-1134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool