Provider Demographics
NPI:1760603559
Name:RIEDER, SHERRY
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:
Last Name:RIEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 CANNON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5717
Mailing Address - Country:US
Mailing Address - Phone:843-259-0794
Mailing Address - Fax:866-804-4951
Practice Address - Street 1:152 CANNON ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5717
Practice Address - Country:US
Practice Address - Phone:843-259-0794
Practice Address - Fax:866-804-4951
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC958103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical