Provider Demographics
NPI:1548393721
Name:GOLDBERG, SHERYL I (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:I
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:I
Other - Last Name:BUCHATLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:ADRIAN PSYCHOTHERAPY ASSOCIATES
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49287-0093
Mailing Address - Country:US
Mailing Address - Phone:517-264-2287
Mailing Address - Fax:517-264-2287
Practice Address - Street 1:604 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221
Practice Address - Country:US
Practice Address - Phone:517-264-2287
Practice Address - Fax:517-264-2287
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010608851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical