Provider Demographics
NPI:1639146251
Name:PATERAK, SHERRY R (MFT)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:R
Last Name:PATERAK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:BRANDY
Other - Last Name:PATERAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:1000 BUSINESS CENTER CIR STE 209
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1250
Mailing Address - Country:US
Mailing Address - Phone:805-298-2710
Mailing Address - Fax:
Practice Address - Street 1:1000 BUSINESS CENTER CIR STE 209
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-1250
Practice Address - Country:US
Practice Address - Phone:805-298-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAADE 010477101YA0400X
CAMFT44582106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT44582OtherCA LICENSE
CA26-0261917OtherTAX ID NUMBER