Provider Demographics
NPI:1013958206
Name:PETERSEN TOMASINO, SHERRYL JESSICA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERRYL
Middle Name:JESSICA
Last Name:PETERSEN TOMASINO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:41921 WHITE POINT BEACH RD
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-5736
Mailing Address - Country:US
Mailing Address - Phone:301-751-4717
Mailing Address - Fax:301-475-2102
Practice Address - Street 1:22660 WASHNGTON ST
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-0604
Practice Address - Country:US
Practice Address - Phone:301-475-2020
Practice Address - Fax:301-475-2102
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDO1671103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical