Provider Demographics
NPI:1629488275
Name:VALLANCE, SHERRY (LBSW)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:VALLANCE
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 KANSAS CITY RD
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6922
Mailing Address - Country:US
Mailing Address - Phone:575-258-3252
Mailing Address - Fax:575-258-5743
Practice Address - Street 1:117 KANSAS CITY RD
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6922
Practice Address - Country:US
Practice Address - Phone:575-258-3252
Practice Address - Fax:575-258-5743
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-07865104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker