Provider Demographics
NPI:1558514372
Name:MOSS, SHERRY (MA)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:ELLEN
Other - Last Name:BERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2806
Mailing Address - Country:US
Mailing Address - Phone:617-969-6668
Mailing Address - Fax:
Practice Address - Street 1:24 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-2806
Practice Address - Country:US
Practice Address - Phone:617-969-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMFT 399101Y00000X
MALMC 770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor