Provider Demographics
NPI:1942485057
Name:SHERRY, JOSEPH EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:SHERRY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:EDWARD
Other - Last Name:SHERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-1630
Mailing Address - Country:US
Mailing Address - Phone:814-274-8651
Mailing Address - Fax:814-274-8652
Practice Address - Street 1:110 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-1939
Practice Address - Country:US
Practice Address - Phone:814-776-0250
Practice Address - Fax:814-776-1470
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0161991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical