Provider Demographics
NPI:1710250923
Name:MARTIN, SHERRI BERNADETTE (LISAC)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:BERNADETTE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 E SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:ARIZONA
Mailing Address - Zip Code:85296
Mailing Address - Country:UM
Mailing Address - Phone:480-888-6182
Mailing Address - Fax:
Practice Address - Street 1:4151 E SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2384
Practice Address - Country:US
Practice Address - Phone:480-888-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-18
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC11572101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)