Provider Demographics
NPI:1396704193
Name:SHERWOOD, ANDREA RAE (PHD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:RAE
Last Name:SHERWOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CONSTITUTION AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1243
Mailing Address - Country:US
Mailing Address - Phone:505-270-4242
Mailing Address - Fax:
Practice Address - Street 1:3400 CONSTITUTION AVE NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1243
Practice Address - Country:US
Practice Address - Phone:505-270-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0929103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28984285Medicaid