Provider Demographics
NPI:1972050193
Name:WAKEHAM, CHERI (LMSW)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:WAKEHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MARY ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4802
Mailing Address - Country:US
Mailing Address - Phone:315-702-3704
Mailing Address - Fax:
Practice Address - Street 1:146 NORTH STREET.
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4802
Practice Address - Country:US
Practice Address - Phone:315-702-3704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health