Provider Demographics
NPI:1659453124
Name:BISHOP, BIDDY SHERMAN (MA, CRC, CDMS)
Entity Type:Individual
Prefix:
First Name:BIDDY
Middle Name:SHERMAN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MA, CRC, CDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 GIBSON AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2719
Mailing Address - Country:US
Mailing Address - Phone:631-385-2068
Mailing Address - Fax:631-385-2068
Practice Address - Street 1:33 GIBSON AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2719
Practice Address - Country:US
Practice Address - Phone:631-385-2068
Practice Address - Fax:631-385-2068
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC-18090225400000X, 101Y00000X, 101YA0400X, 101YM0800X, 225C00000X
NY00003636171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1659453124Medicaid