Provider Demographics
NPI:1265611214
Name:SHARP, JAY BERARD (LISW)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:BERARD
Last Name:SHARP
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N HIGH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1142
Mailing Address - Country:US
Mailing Address - Phone:614-261-1095
Mailing Address - Fax:614-882-3908
Practice Address - Street 1:3400 N HIGH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1142
Practice Address - Country:US
Practice Address - Phone:614-261-1095
Practice Address - Fax:614-882-3908
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional