Provider Demographics
NPI:1134586597
Name:SULLIVAN, SHERRY LYNNE (LCSW-C)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNNE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 BELAIR RD
Mailing Address - Street 2:SUITE G4
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3025
Mailing Address - Country:US
Mailing Address - Phone:410-800-2169
Mailing Address - Fax:410-777-8742
Practice Address - Street 1:8441 BELAIR RD
Practice Address - Street 2:SUITE G4
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3025
Practice Address - Country:US
Practice Address - Phone:410-800-2169
Practice Address - Fax:410-777-8742
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD095771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical