Provider Demographics
NPI:1568719086
Name:SHERIDAN, ERIN (LADC, LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:LADC, LPC, LMHC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SHERIDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC, LPC, LMHC
Mailing Address - Street 1:1 MAIN ST # 120
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01010-9800
Mailing Address - Country:US
Mailing Address - Phone:860-362-0770
Mailing Address - Fax:860-779-5437
Practice Address - Street 1:1 MAIN ST # 120
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:MA
Practice Address - Zip Code:01010-9800
Practice Address - Country:US
Practice Address - Phone:860-362-0770
Practice Address - Fax:860-362-0771
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001092101YA0400X
CT003436101YP2500X
MA12596MHCC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040564Medicaid
CT004040564Medicaid
MAY10400Medicare PIN
MAM18684OtherBLUE CROSS BLUE SHEILD