Provider Demographics
NPI:1518924588
Name:SHERTZER, CAROLYN L (PHD)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:L
Last Name:SHERTZER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 N LIME ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2950
Mailing Address - Country:US
Mailing Address - Phone:717-299-5433
Mailing Address - Fax:717-393-3973
Practice Address - Street 1:43 N LIME ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2950
Practice Address - Country:US
Practice Address - Phone:717-299-5433
Practice Address - Fax:717-393-3973
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002910L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASH134259Medicare ID - Type Unspecified