Provider Demographics
NPI:1841592920
Name:COPELAND, SHERRY CAROL (LICSW)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:CAROL
Last Name:COPELAND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GREGLEN AVENUE PMB 294
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554
Mailing Address - Country:US
Mailing Address - Phone:508-292-7655
Mailing Address - Fax:
Practice Address - Street 1:2 GREGLEN AVE
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-2830
Practice Address - Country:US
Practice Address - Phone:508-292-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2157271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical