Provider Demographics
NPI:1912129388
Name:SHERWOOD, JAMES VINCENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VINCENT
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:WAINSCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:11975-0097
Mailing Address - Country:US
Mailing Address - Phone:631-537-6700
Mailing Address - Fax:
Practice Address - Street 1:386 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:WAINSCOTT
Practice Address - State:NY
Practice Address - Zip Code:11975
Practice Address - Country:US
Practice Address - Phone:631-537-6700
Practice Address - Fax:631-537-7370
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0134841103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist