Provider Demographics
NPI:1720687742
Name:HUGHES, SHERITA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHERITA
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHERITA
Other - Middle Name:N
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:3900 WOODLAND AVE
Mailing Address - Street 2:SW122
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4594
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:SW122
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19104-4594
Practice Address - Country:US
Practice Address - Phone:215-823-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136162104100000X
PACW0227491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker