Provider Demographics
NPI:1538501168
Name:SHERYL WELTON, LCSW
Entity Type:Organization
Organization Name:SHERYL WELTON, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WELTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:321-600-0696
Mailing Address - Street 1:4630 LIPSCOMB ST NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2940
Mailing Address - Country:US
Mailing Address - Phone:321-600-0696
Mailing Address - Fax:321-821-2340
Practice Address - Street 1:4630 LIPSCOMB ST NE
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2940
Practice Address - Country:US
Practice Address - Phone:321-600-0696
Practice Address - Fax:321-821-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7473251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health