Provider Demographics
NPI:1205919669
Name:ELLERY, SHERYLL A (LMHC, CADAC)
Entity type:Individual
Prefix:
First Name:SHERYLL
Middle Name:A
Last Name:ELLERY
Suffix:
Gender:F
Credentials:LMHC, CADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6722
Mailing Address - Country:US
Mailing Address - Phone:413-446-7818
Mailing Address - Fax:
Practice Address - Street 1:25 HENRY AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6722
Practice Address - Country:US
Practice Address - Phone:413-446-7818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YA0400X
MA5990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5990OtherLMHC