Provider Demographics
NPI:1972825131
Name:GIBSON, SHERRY LYNN (LISW)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LYNN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 WRENFORD RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-2014
Mailing Address - Country:US
Mailing Address - Phone:216-378-2645
Mailing Address - Fax:216-378-2645
Practice Address - Street 1:526 SUPERIOR AVE E
Practice Address - Street 2:SUITE 740
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-1902
Practice Address - Country:US
Practice Address - Phone:216-664-1590
Practice Address - Fax:216-664-1590
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.10000031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical