Provider Demographics
NPI:1649534215
Name:STAHL, SHERIN SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHERIN
Middle Name:SUE
Last Name:STAHL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 TUCKER MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1943
Mailing Address - Country:US
Mailing Address - Phone:203-671-1547
Mailing Address - Fax:203-764-9110
Practice Address - Street 1:7 TUCKER MEADOW RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-1943
Practice Address - Country:US
Practice Address - Phone:203-671-1547
Practice Address - Fax:203-764-9110
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002643103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent