Provider Demographics
NPI:1801909924
Name:WELTON, SHERYL A (LCSW)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:A
Last Name:WELTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 HUNTER LN
Mailing Address - Street 2:
Mailing Address - City:MALABAR
Mailing Address - State:FL
Mailing Address - Zip Code:32950-3805
Mailing Address - Country:US
Mailing Address - Phone:321-676-2078
Mailing Address - Fax:
Practice Address - Street 1:1900 PALM BAY RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2955
Practice Address - Country:US
Practice Address - Phone:321-636-9941
Practice Address - Fax:321-636-0915
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 74731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical