Provider Demographics
NPI:1508934654
Name:CERIDAN, SHERRY (PSYAD MA RN)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:
Last Name:CERIDAN
Suffix:
Gender:F
Credentials:PSYAD MA RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MASSACHUSETTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-534-4212
Mailing Address - Fax:617-534-4221
Practice Address - Street 1:774 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2520
Practice Address - Country:US
Practice Address - Phone:617-534-4212
Practice Address - Fax:617-534-4221
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA146216163WA0400X
102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)