Provider Demographics
NPI:1689742470
Name:BOLIN, SHERYL L (LCSW)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:L
Last Name:BOLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:L
Other - Last Name:STAPINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8400 LOUISIANA ST.
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6385
Mailing Address - Country:US
Mailing Address - Phone:219-757-1928
Mailing Address - Fax:219-757-1950
Practice Address - Street 1:2600 HIGHWAY AVE.
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1613
Practice Address - Country:US
Practice Address - Phone:219-972-0131
Practice Address - Fax:219-972-9104
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003146A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400041760Medicare PIN