Provider Demographics
NPI:1295889251
Name:ADELMAN, SHARON GWEN (LICSW)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:GWEN
Last Name:ADELMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SEDGWICK ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2836
Mailing Address - Country:US
Mailing Address - Phone:617-524-8523
Mailing Address - Fax:617-522-9675
Practice Address - Street 1:705 CENTRE ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2598
Practice Address - Country:US
Practice Address - Phone:617-522-2921
Practice Address - Fax:617-524-4151
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1073331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1851691Medicaid
MAPO 7610OtherBLUE CROSS BLUE SHIELD OF
MAPO 7610OtherBLUE CROSS BLUE SHIELD OF