Provider Demographics
NPI:1578075057
Name:GREEN, SHERRY LEA
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEA
Last Name:GREEN
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 1:239 SUSSEX L
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-6833
Mailing Address - Country:US
Mailing Address - Phone:561-401-5764
Mailing Address - Fax:
Practice Address - Street 1:350 FAIRWAY DRIVE SUITE 101A
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-6407
Practice Address - Country:US
Practice Address - Phone:954-947-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician