Provider Demographics
NPI:1932438876
Name:SHERIDAN, JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 SE ALBERTINE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-5191
Mailing Address - Country:US
Mailing Address - Phone:503-277-3077
Mailing Address - Fax:
Practice Address - Street 1:20595 SW TV HWY
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-1767
Practice Address - Country:US
Practice Address - Phone:503-277-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL44871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical