Provider Demographics
NPI:1508905621
Name:FLOURNOY, SHERRI MICHELE (LCSW R)
Entity Type:Individual
Prefix:MS
First Name:SHERRI
Middle Name:MICHELE
Last Name:FLOURNOY
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:MICHELE
Other - Last Name:PETTIFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:1150 OSSIPEE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552
Mailing Address - Country:US
Mailing Address - Phone:516-536-1835
Mailing Address - Fax:
Practice Address - Street 1:87 - 86 188TH STREET
Practice Address - Street 2:1 LEVEL
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423
Practice Address - Country:US
Practice Address - Phone:917-863-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05325811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02705Medicare UPIN