Provider Demographics
NPI:1770551186
Name:THOMPSON, SHERRY GARDNER (LCSW, RN)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:GARDNER
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7543 N LEEWYNN DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8793
Mailing Address - Country:US
Mailing Address - Phone:941-371-1162
Mailing Address - Fax:
Practice Address - Street 1:1750 17TH ST
Practice Address - Street 2:J2
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-8632
Practice Address - Country:US
Practice Address - Phone:941-552-2075
Practice Address - Fax:941-552-2079
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7691041C0700X
FLRN1261672163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN1261672OtherREGISTERED NURSE
FLSW769OtherLIC. CLINICAL SOC. WORKER