Provider Demographics
NPI:1467589374
Name:KISSNER, SHERYL ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANN
Last Name:KISSNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:KISSNER
Other - Last Name:BATTAGLIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1701 GATEWAY BLVD
Mailing Address - Street 2:SUITE 465
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3572
Mailing Address - Country:US
Mailing Address - Phone:972-679-5577
Mailing Address - Fax:972-644-2159
Practice Address - Street 1:1701 GATEWAY BLVD
Practice Address - Street 2:SUITE 465
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3572
Practice Address - Country:US
Practice Address - Phone:972-679-5577
Practice Address - Fax:972-644-2159
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX285771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical