Provider Demographics
NPI:1689077950
Name:SHERIDAN, BRENDAN (LCSWR)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 WITTENBERG RD
Mailing Address - Street 2:
Mailing Address - City:BEARSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12409-5629
Mailing Address - Country:US
Mailing Address - Phone:845-627-4817
Mailing Address - Fax:
Practice Address - Street 1:163 WITTENBERG RD
Practice Address - Street 2:
Practice Address - City:BEARSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12409-5629
Practice Address - Country:US
Practice Address - Phone:845-627-4817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR080577-11041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool