Provider Demographics
NPI:1467720227
Name:SHERMAN, DANIELLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S GLENDORA AVE
Mailing Address - Street 2:SUITE B1
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3443
Mailing Address - Country:US
Mailing Address - Phone:909-493-4426
Mailing Address - Fax:
Practice Address - Street 1:224 S GLENDORA AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3443
Practice Address - Country:US
Practice Address - Phone:909-493-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL