Provider Demographics
NPI:1841361227
Name:SHERMAN, MONIQUE T (LICSW)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:T
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:TERESE
Other - Last Name:SHERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW/LICSW
Mailing Address - Street 1:174 SOUTH RD
Mailing Address - Street 2:STE 117
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4414
Mailing Address - Country:US
Mailing Address - Phone:413-313-6431
Mailing Address - Fax:
Practice Address - Street 1:174 SOUTH RD
Practice Address - Street 2:STE 117
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4414
Practice Address - Country:US
Practice Address - Phone:413-313-6431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0055921041C0700X
MA1216071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800003283Medicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER