Provider Demographics
NPI:1255949715
Name:SHERBLOM, ADAM
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:SHERBLOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 RESERVOIR ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1208
Mailing Address - Country:US
Mailing Address - Phone:508-579-0895
Mailing Address - Fax:
Practice Address - Street 1:354 RESERVOIR ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1208
Practice Address - Country:US
Practice Address - Phone:508-579-0895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health