Provider Demographics
NPI:1538129457
Name:SHARNOFF, WENDY SUE (LISW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:SUE
Last Name:SHARNOFF
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8003
Mailing Address - Country:US
Mailing Address - Phone:803-434-4300
Mailing Address - Fax:803-434-4277
Practice Address - Street 1:15 MEDICAL PARK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8003
Practice Address - Country:US
Practice Address - Phone:803-434-4300
Practice Address - Fax:803-434-4277
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQM0436Medicaid
SCQM0436Medicaid
SCQ32304411Medicare PIN
Q32030Medicare UPIN