Provider Demographics
NPI:1619620077
Name:HERARD, SHERLINE (MENTAL HEALTH INTERN)
Entity Type:Individual
Prefix:
First Name:SHERLINE
Middle Name:
Last Name:HERARD
Suffix:
Gender:F
Credentials:MENTAL HEALTH INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 DEL PRADO BLVD S STE 135
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3782
Mailing Address - Country:US
Mailing Address - Phone:786-771-1375
Mailing Address - Fax:
Practice Address - Street 1:1404 DEL PRADO BLVD S STE 135
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3782
Practice Address - Country:US
Practice Address - Phone:786-771-1375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH19730101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health