Provider Demographics
NPI:1568892057
Name:IZLAR-CARR, SHERRELL
Entity Type:Individual
Prefix:
First Name:SHERRELL
Middle Name:
Last Name:IZLAR-CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10408 TERRACO DR
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20623-1200
Mailing Address - Country:US
Mailing Address - Phone:240-375-2143
Mailing Address - Fax:301-372-8927
Practice Address - Street 1:10408 TERRACO DR
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:MD
Practice Address - Zip Code:20623-1200
Practice Address - Country:US
Practice Address - Phone:240-375-2143
Practice Address - Fax:301-372-8927
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500803881041C0700X
MD138701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical