Provider Demographics
NPI:1639281041
Name:EDMONDS-CLEMONS, SHERRY (MSW, LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:
Last Name:EDMONDS-CLEMONS
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15900 LAVENDER DREAM LN
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-8012
Mailing Address - Country:US
Mailing Address - Phone:301-782-7874
Mailing Address - Fax:301-295-0471
Practice Address - Street 1:50 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:301-295-5004
Practice Address - Fax:202-745-8342
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD073531041C0700X
DCLC3028701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD07353OtherCERTIFIED SOCIAL WORKER-C
MD07353OtherCERTIFIED SOCIAL WORKER-C