Provider Demographics
NPI:1659406726
Name:NELSON, CHERYL (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 NORTH ROAD
Mailing Address - Street 2:ST. FRANCIS HOSPITAL
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-483-5199
Mailing Address - Fax:845-483-5525
Practice Address - Street 1:ST. FRANCIS HOSPITAL
Practice Address - Street 2:241 NORTH ROAD
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-483-5199
Practice Address - Fax:845-483-5525
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044901-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044901-1OtherLICENSE